SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 6 Number 1 January, 1999 SIS ISSN 0971 - 6610 Vol. 6, No. 1 Pgs. 1-90 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 1999

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is published twice a year (January, July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counselling, cross cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION: Manuscripts should be typewritten (double spaced throughout) submitted in duplicate to B.L. Dubey, Ph.D. Chief Editor SIS Journal, P.O.Box 1107, Sector-15 Post Office, Chandigarh 160015 (India). Manuscript can also be submitted to Wilfred A. Cassell. M.D., Editor, 4105 Tudor Center Drive, Space B-6, Anchorage, AK-99508 (USA). The Editors reserve the right to refuse manuscript submitted and to make minor additions/ deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment. SUBSCRIPTION : The journal is free to members of the Society, Annual membership fees are US $40 for foreign members and Rs. 150, for Indian members, Institutional subscriptions are US $100 for Foreign institutions and Rs. 500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 1000 for Indian members. Non-members may subscribe for $25 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, SIS Center, P.O.Box 1107, Sector-15 Post Office, Chandigarh-160015 (India), Tel/Fax 91-172-710986, E-Mail: sisdubey@ch1.dot.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 (U.S.A.) 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 U.S.A./India

SIS Journal of Projective Psychology & Mental Health Volume 6, Number 1, January 1999 Page Nos. 1. Editorial : "Touch-Me-Not" Attitude and Mental Health. S. K. Verma 1-2 2. A Video Projective Technique for PTSD in Women. Mary A. 3-28 Cassell, Wilfred A. Cassell, B. L. Dubey, Padma Dwivedi, Elaine Molchanov, Ann M. O'Roark & Lisa C. Routh 3. A Comparative Study of Personality Problems of Russian and 29-33 American Female Adolescents. Anatoly B. Khromov, Wilfred A. Cassell & B. L. Dubey 4. Some Personality Correlates of Selected SIS Variables : 35-46 Russian Experience. Anatoly B. Khromov, Wilfred A. Cassell & B. L. Dubey 5. SIS-Video in a Case of Depression. M. K. Tewari & 47-49 Padma Dwivedi 6. Effect of Age and Sex on the Length of the Protocol of SIS-II 50-52 Images. M. P. Singh, Mridula Mishra & Nalini Mishra 7. Evaluation of Piotrowski's Organic Signs of Head Injury. 53-57 S. Chaudhury, T. R. John. H. S. Bhatoe & S. Rohatgi 8. Maintaining Mental Health of the Aged through Psychosynthesis. 58-60 N. L. Dosajh 9. How Repression of Spiritual Urge Leads to Psychological 61-64 Troubles. N. L. Dosajh 10. A Proposed Model for Quantification of Abnormal Somatic 65-68 Concern on SIS-II. S. K. Verma & Harprit Kaur 11. Comparative Efficacy of Pharmacotherapy and Bio-feed 69-77 Back among Cases of Generalised Anxiety Disorder. P. Sarkar, S. P. Rathee & N. Neena 12. Membership Directory 79-84 Contents

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 AND 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 Jr. 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.dot.net.in OR sisdubey@hotmail.com

Editorial "Touch-Me-Not" Attitude and Mental Health Clinical psychology is a helping profession, and deals with mental health problems of the population-both positive mental health like quality of life, well-being, satisfaction, adjustment, self-realization etc. as well as negative mental health like dissatisfaction, maladjustment, anxiety, depression, fears, phobias, obsessivecompulsive decisions, etc. To what extent we are able to achieve our goals is dependent upon a number of factors, some of them not under our direct control. One of these factors not under our direct control is the groups/societies unwillingness to help themselves and their fellow-beings. Sometimes they also do not want to be helped. Sometimes want to be helped but do not want to even lift their little finger to be helped-rather they want others to do their things for them inspite of their own poor motivation. They feel it is others duty to help them under all situations. They do know and can repeat parrot like-that even God helps those who help themselves-and that you can bring a horse to water but cannot make him drink it. Both these groups of patients are difficult to treat. They have to be motivated to be helped. Before treatment starts cooperation and compliance have to be ensured. The question remains how to ensure these? It is important here to establish a good working rapport with the patient and/or with his family-preferably with both-and to see that no one-I repeat-no one near the patient or his/her family, motivates them against the offered treatment. Otherwise the danger is that either the patient will not come for treatment or, will not comply with treatment plans, seeking and finding faults in the treatment ordered. Once this is ensured, the next question comes, how to make the treatment instructions acceptable, attractive and meaningful. The four principles of Sam, Dam, Dand, Bhed have to be applied for this purpose to ensure strong, regular, motivation to be helped. The last but not the least important question is... what can be done and how it can be done? Are there methods and tools that can help in this matter? The answer seems to be yes. We can make the treatment plan as attractive, the method as acceptable and palatable and resistance as little... as possible. A good example would be the use of Somatic Inkblot Series... particularly its Video Version. A combination of sound, colour and movement may do the trick for most cases, to which can be added the highly suggestive background and good working rapport. Once the ice is broken, rest of the things may be easier, A suitable talk by the therapist before, during and after the SIS session, emphasizing the need, importance and usefulness of being the good and effective producers of mental health (persuading and helping others) as opposed to passively

remaining poor consumers of limited mental health resources of a developing country like India. Many patients and their relatives are quite demanding of attention and of helps (whatever they might mean by it), are resentful of any delays in its delivery and are too sensitive to be helpful to their fellow beings (others/patients). They however are potential producers and advocates/messangers of mental health services... and remain our most effective tools in any long term treatment and preventive measures for mental health. We all are quite fortunate and rich in this so far an untapped human resource. Instead of passively and helplessly watching the things to take their own sweet time for this, the time is right for making active, forceful attempt in this direction. Instead of the distant "touch-me-not" attitude, one needs to adopt "by-all-means, I am ready" attitude, which is positive, acceptable and likely to prove effective and fruitful in the area of mental health. The role of SIS has not been fully realized to turn about this attitudinal change in the right, desirable direction... hence the need to take the necessary first step, here, now and without any further unpardonable delays in it. The successfully treated psychiatric patients would prove to be the most useful tools in breaking the resistance of such patients... and in spreading the right knowledge among the masses. "Touch-menot attitude" is an infectious and harmful attitude and it is best to nip it in the bud itself, while the going is good... that is... before the "touch-me-not" attitude takes deep roots in the minds of patients and their families. We just cannot afford to leave them alone, at the mercy of misinformed, misguided, so-called "experts"/wisemen/quacks. We do hope that in the times to come SIS technique would take further roots in the fields of mental health, in every country of the world and would help correct this fast spreading, faulty and dangerous trend. It is in the best interest of us all... the professional members of the helping profession. Dr. S.K. Verma, Ph.D. Consultant Clinical Psychologist Dept. of Psychiatry, Government Medical College and Hospital, Sector 32, Chandigarh (INDIA) 2 Verma

A Video Projective Technique for PTSD in Women Mary A. Cassell; Wilfred A. Cassell; B.L. Dubey; Padma Dwivedi; Elaine Molchanov; Ann M. O’Roark and Lisa C. Routh The follwing article introduces an extension of the SIS Method and outlines the development and clinical applications of the video, “Living Images”. This television technique, an animated, colorful presentation of 40 images, prepared by women artist, effectively aides in the psychological evaluation and treatment of a spectrum of feminine health problems. These gender- specific experiences range in severity from minor stressful situations to severe ones associated with abuse issues and PTSD (Posttraumatic Stress Disorder). Clinical work with the Somatic Inkblot Series (SIS)which can also be administered by video technique, suggests that this projective technique ("Living Images") can be a useful aide in the assessment and treatment of PTSD unique to women. The following sections address projective techniques and PTSD, a description of "Living Images" excerpts from the sound script and applications of the technique in three cases "Living Images" opens with trance-inducing floral prelude to the presentation of structured inkblots, and, in a sense, serves as an electronic time machine, allowing the viewer to connect directly with past events and memories. When viewers are instructed to draw what is visualized, it makes it possible to access imagery directly without the constraints of language. Employment of hypnotic- like induction instructions to focus on relaxing body sensations and deep breathing make it more body-oriented (i.e. right brain) than cognitive. Traumatized women project responses onto the inkblots, as though they are reexperiencing their past stressful life events in the clinical setting. Content analysis of the projections reflects their original traumatic images and painful emotions, either directly or in a symbolically disguised fashion. Given this clinical observation, a new series of stimuli were designed with embedded structure, artistically created to stimulate imagery considered unique to women’s life stresses. In the designing of new projective approach, a decision was made to avoid labelling it as a “test”. It was not just developed for psychometric research concerned with statistical norms, measurement of concepts of validity, reliability, etc. In the United States and elsewhere, most of the treatment for PTSD is provided by mental health care specialists in disciplines Mary A.Cassell, Wilfred A.Cassell, Lisa C. Routh and Elaine Molchanov, SIS Center, 4105 Tudor Center Drive Anchorage, AK-99508(USA), B.L.Dubey & Padma Dwivedi, SIS Center, India, Ann M.O’Roark, 866 Amelia Court, NE, St. Petersburg, Fl 33702-2784(USA) For reprints please write to: Somatic Inkblot Center, PO Box 1107, Sector-15 Post Office, Chandigarh-160017(India)

such as social work, psychiatric nursing, art therapy, pastoral counselling, etc. When conceived, while it was anticipated that the envisioned video would assist in the assessment and diagnosis, it was primarily intended to be an aide to therapy. Moreover, because of its effectiveness in stimulating traumatic imagery, it is particularly relevant for training clinicians who employ visualization techniques such as art therapists, sand tray therapists, EMDR therapists, etc. Although no specific education in projective testing is required , it is essential to have an understanding of the therapy issues and treatment plan requirements for managing disorders induced by stressful life events. The inkblots were designed specifically for use by clinicians who treat women suffering from the deleterious effects of psychological trauma related to sexuality and reproduction. Projective Techniques and PTSD Much of the existing research on PTSD has employed interviews and various self- report scales. More recently, professionals have contended that projective measures could enrich the insights provided by these approaches ( e.g. Allen,1994). Also, investigators contend that the complexity of PTSD necessitates a multi-method approach and multidimensional assessment system (Kulka et al., 1991; Malloy, Fairbank, and Keane, 1983; Sutker et, al, 1991). As might be expected, the majority of projective studies have been based upon the Rorschach. Most of these have been conducted with veterans traumatized by war (Frueh and Kinder, 1994; Hartmena et al, 1990; Van der Kolk and Ducey, 1989). A few have examined non-military victims of trauma (Kaser-Boyd, 1993; Leifer, Shapiro, Martone, & Kassem, 1991; Levin, 1993; Saunders, 1991). Strictly speaking, just because the study employs the Rorschach does not mean that their scores were based upon the assessment of projected traumatic imagery. For example, if the numerical data employs scales such as those derived by Exner’s scoring system, it would be erroneous to categorize them as derived from “ projective” testing. One promising projective test , the Hand Test (Wagner, 1983) has been used in studying PTSD in veterans (Walter, Hilsenroth, Arsenault, Sloan and Harvill 1998). However, it has been employed more in the assessment of noncombat traumatized individuals (Dalton and Kanter, 1983; Gianokos and Wagner, 1987; Rasch and Wagner, 1989). Another procedure developed by Walker(1981, 1986, 1991) employing four ambigious photographic images as an aide in psychotherapy has also been effectively employed in the assessment and treatment process for trauma. In reviewing the latter technique, Bessel A Van der Kolk (1998) observed that 4 Cassell et al

"with the current understanding that trauma is primarily 'remembered' as emotional states and body sensations, with limited verbal representation, the Walker Visuals come as a welcome addition to the therapists' armamentarium to help patients access the feelings and personal experiences that can keep them stuck in living the present as a mere extension of the past". Description of Living Images The video uses relaxing floral painting by Sara Steele, a nationally known American artist sympathetic to feminists issues. When these are presented in association with a sound track of suggestions inducing relaxation, the video technology facilitates travel of the psyche back to past traumatic periods. This gives it powerful pulling power to evoke imagery which may have been forgotten or even split off from consciousness - as occurs in the Dissociative Disorders. Compared to standard clinical interviews, the hypnotic and sensory quality of the video more readily accesses PTSD memories for therapeutic processing. Since it employs projective principles stimulating imagery, it facilitates the communication of recurrent and intrusive recollections of the stressful event, including images, thoughts and perceptions. It taps into the same stream of disturbed consciousness as that of recurrent distressing dreams. For those who have not been able to recall or verbally express the content of traumatic encompassing “nightmares” (e.g.: children), it may enable access to this forgotten or repressed imagery. It also is helpful to those who have experienced confusion, as if the traumatic episodes were reoccurring, such as a sense of reliving the experience, illusions, visual hallucinations and dissociative flashback episodes. Activating the imagery in memory storage can provide an opportunity to cognitively correct irrational thinking, while releasing the associated emotions in the relative safety of the therapeutic setting. Although the latter may be highly painful, the release and expression of such affect can open up the person’s emotional life. It there by can effectively neutralize the avoidance and numbing following trauma. The video tape uses forty color-form stimulus arrays. Most are not inkblots in the traditional sense, but rather, represent semi structured artistic creations. A few of the “inkblots” were manipulated by special video effects to induce movement on the television screen. Overall, they range from those with relatively little human or somatic structure to those with a high degree of characteristics for stimulating imagery depicting feminine health issues. They were designed by female artists so as to more accurately project feminine physical, psychological and spiritual dimensions. They represent mental Living Images in PTSD 5

projections only of females. The video presentation facilitates the introduction of life-like moving visual stimuli which can recapitulate the fluctuating quality of dreams, hence the name “Living”. To have universal applicability, the artists were requested to make the human content in the blots free of culture connections as was artistically possible. Initially, in the video, the viewer observes a young woman in shimmering dreamlike waves symbolizing psychical travel through the dimensions of time and space. These scenes are accompanied by an enhancing musical soundtrack. The feminine form was made to appear rigid, initially denoting a defensive posture. This is consistent with the notion that traumatized individuals frequently guard against the emergence of painful memories by inhibition of motor and sensory responses. Highly defended individuals readily identify with the symbolized body language. Repetition of the woman’s body in various beautiful colors eventually tends to induce a relaxation effect calculated to open the viewer’s memory storage. These dream-like images are then presented in association with verbal suggestions to relax. This auditory input includes instructions concerning how to respond to test video images by a woman who has a soft, hypnotic-like voice. The stage is then set for travelling back in time to past traumatic periods. During the visualization of the video, the unresolved effectual pain psycho-physiologically activates recollection processes in the brain, thereby facilitating release of PTSD imagery from memory storage. These are then projected onto the structured inkblots. A Transcript of the Sound-track “This is an exciting time to be a woman...as women’s abilities are now widely acknowledged and accepted. Today we have many opportunities to develop our feminine personalities using our special strengths... We also are learning to understand and deal more effectively with our unique problems...One way to have greater understanding is through psychological interviews and testing...The images that you will soon see were designed specially for women by female artists...They will provide the opportunity to explore the depths of feminine consciousness...Be sure to include how the images make you feel...Everything is important...These images may bring to mind something that you have experienced recently...something in your past...or maybe in your dreams and fantasies...Here are two helpful examples:” Next, a sound track of two women is presented communicating their reactions to an image provided for the purpose of illustration: 6 Cassell et al

Subject #1: “It looks like a butterfly or flower... an opening... color.” Subject #2: “It looks like a lamp or chandelier in some ways it looks like... not a glowing sky but a thunder and lightning sky... it looks ominous to me... with an insect inside of everything... it looks like it might be coming to get me or something like that.” Finally, the voice of the instructor returns with the following relaxation inducing suggestions: “Most of us find it useful to relax before viewing these images...Feel your self unwind...relax...breath deeply...feel the muscles throughout your body relaxing...Now concentrate on the screen and enjoy the experience.” While the video needs to be used under the supervision of trained personnel, experienced in treating stress disorders, it may be viewed in isolation without the presence of a professional. This reduces test anxiety related to an examiner’s presence during the highly personal projective process. It also more closely approximates dreams - an important source of the projected imagery. When clinically indicated, it also may be viewed on one or more occasions. Repeated activation of the PTSD imagery in association with the relaxing qualities of the video can provide a type of behavioural therapy desensitization (Cassell, 1977). Moreover, the viewing may be aided by the presence of an emphathetically supportive person who shares the victim’s Cultural background and language. In certain settings, it can be therapeutically worthwhile as a television presentation for cognitively and emotionally processing stress disorder in women’s group psychotherapy. Clinical Case Illustration Three clinical case histories will be presented to illustrate the use of Living Images in women who met the criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) (The American Psychiatric Association, 1994). The first involves a single woman who was repeatedly raped as a teenager by a relative in his thirties. She sustained permanent physical damage to her reproductive structures. As a result, she was markedly concerned about whether or not she would be able to have children. Her fears surrounding her damaged body image (BI) were reflected in her focus on Image 37 as “A hole in the uterus”. It is evident how such a response could provide a useful starting point to explore her abuse issues as well as her ongoing fears about sterility. The second case involves a middle-aged woman who was temporarily residing Living Images in PTSD 7

in a treatment facility for abused women. She had a long history of the following: repetitive abusive relationships with men, PTSD , Major Depression and Chemical Dependency. The most recent assault had occurred three months prior to viewing Living Images, after she had moved in with a man who abused her psychologically, physically and sexually. Poorly educated , with limited intellectual and verbal skills, she had considerable difficulty communicating about her traumatic experiences in therapeutic interviews. By contrast, in the projective viewing situation, she was more open. However, she was still sufficiently guarded that she could only give very brief responses to the test images. These were easily interpretable with simple content analysis. Her early features of Dissociative Personality Disorder resulting from her long traumatic history were reflected in her projecting these onto Image 10 as “split personality”. Her psychological numbing and isolation from her inner emotions was projected to Image 11 as “detachment”. In viewing Image33, she gave the pathological anatomical response “punch in the eye”, directly denoting previous facial injuries. Horrible images of repeated sexual assault were Projected in the response “A rape... I feel sad.” One does not have to be trained in projective testing and symbolic interpretation to understand the clinical significance of such PTSD inkblot responses. Playback of these specific images as television stimuli in group psychotherapy with other abused women provides a useful follow up therapy technique. The third case was selected to illustrate more sophisticated phenomenological analytic approaches. The victim was a middle-aged woman who, a few days before evaluation, had been savagely raped. She sought therapy suffering from classical features of severe PTSD. She was an intelligent woman , who, years earlier, had worked as a teacher, prior to immigrating to the United States. Past history revealed that a few years earlier, she had been sexually assaulted by a so called family friend. She never reported or sought treatment for this earlier trauma. Being a former teacher, she appreciated the need to develop educational television programs and consented to review her original responses to ‘Living Images” . The teaching tape was first completed in English, with one of the authors as professional interviewer. Then, the detailed inquiry was repeated in the television studio as she was questionned by a woman interviewer in her native language. After briefly reviewing further conceptual background for Living Images, the transcript of the English interview will be presented: 8 Cassell et al

Conceptual Background It is generally recognized that any form of art partially represents a direct projection of the artist’s own psyche and past imagery. For art forms designed to accurately depict physical reality, what is projected onto external physical reality is ordinarily only minimal. For more abstract artistic works, the creator’s subjective inner fantasy life and dream images can alter the production. Visual hallucinations, such as those induced by hallucinogenic drugs or illness, can also influence the work of creative individuals. For example, some neurologists have suggested that Vincent Van Gogh suffered from a form of epilepsy, creating the visual effects evident in his pictures. Similar projective principles operate in those making inkblots for psychological use. In the historical literature on inkblots, one factor which has not been properly addressed concerns the sex of the artist. For creating the original SIS, the services of five artists were utilized. Two were men and three were women (Blots 1A, 2A, 3A, 31A, 1B, 2B, 3B, 4B, 17B, 25B, 28B, 29B, and 31B). Extensive clinical experience with this series in traumatized women suggested that stress related to sexuality and reproduction represent important unresolved areas of trauma. For example, in visually processing SIS image 27B (stimulating fetus imagery), many women released their previously unexpressed anguish regarding past miscarriages (Cassell and Dubey, 1996). After resolving this unresolved emotional pain and suffering, they frequently complained in psychotherapy sessions about their past poor psychological care by obstetrical care providers and their failure to have an appropriate referral for counseling. Many had been clinically dismissed with simple statements such as “a lot of women lose babies , you can always try to get pregnant again”. This professional aversion of many medical practitioners to recognize the need to grieve failed to appreciate the highly stressful nature of such losses. It was anticipated that the Living Images would facilitate the exploration of aspects of feminine consciousness. It is hoped that the series may lead to new therapeutic avenues. Like the original SIS, it was designed in both video and booklet versions. For the purpose of test-retest comparison, two images (17B and 31B) were repeated. To provide visual structure to stimulate imagery denoting “splitting”, such as occurs with severe trauma in the dissociate disorders, the artists designed some of the human content in the inkblots with split figures eg.Image 10 and 11.Lastly, the projective procedure was named, avoiding feminist connotations, as a partial disguise to its primary use for women. It was anticipated that it might also have utility in the assessment of other family members traumatized by stressful issues related to a woman’s reproduction cycle, including males. Living Images in PTSD 9

Interview Following Viewing of Living Images by Case III Interviewer (I) : “ We are going to put the picture from the video, Living Images, that you rated most threatening on the television screen. Please tell us what you see and feel in looking at that again today.”(Image 29) Patient (P) : “Some kind of evil looking at everybody, maybe, special to me, is some kind of the most people have inside. I think some of us, this some evil, like you know it’s got a mean face. I: “And you said that it was like a nightmare for you.” P:“Yes.” I : “What way does that resemble some of the horrible nightmares you have had since trauma.?” P: It’s somebody trying to do something wrong to me and I try to, to tell everybody that people don’t listen and I try to aware the people for something dangerous and nobody listen; they don’t understand; it’s like talk in another language completely.” I “It was horrible going through the experience and then when people wouldn’t listen, that was even worse in some ways. Tell us about the dream that you had that reflected symbolically that aspect of no one listening.” P: “Well, I had one dream, that I was in front of a beautiful window, a big window, and the ocean was blue and beautiful, the other side and there’s a ship far away and I called my mother, my mother is died, and my grandma and son and these people are already dead. But they are coming to see me, but then the moment they started in front of the window the ocean come to be furious and change color to be gray and the ship coming and coming and I try to warn they need to move back, but they come to the window and I wake up, I think blooded or something, I wake up very bad.” I: “Do you feel that ?” P: “Exactly, the people don’t listen, don’t pay attention because you are aware something is dangerous.” I: “And after the rape trauma, how did you find that no one seemed to want to listen?” P: “Because everybody tell, oh that’s OK, that’s nothing, that’s not true, they think, you know like that will go away in a few days and that’s not the, the, the 10 Cassell et al

inside is never the same, we never are the same, we need some people understand, we need to be ready for situation like that, nobody ready for that.” I: “Please tell us what happened this Thursday a week ago.” P: “Yes, I was working, working a hotel and I supposed to check a room, a empty room to see if the status is clean or no, and it’s terrible, and but I saw this guy before and I know on another floor, I go to tell the leader Phillips another floor and I saw this guy crossing and I said good evening like we need supposed to doing and I take the elevator, the guest elevator to the other floor and I go inside the room and when I’m coming out this guy coming from the elevator and he jumped on me and stabbed my neck and pushed me inside the room and he not say nothing- he don’t know me, he no say anything, he start to close and close and he go in back me and have my hand tie my hand and he start to get the other hand to check my clothes and go inside me- with my hand I scratched his face, I feel that his eyes and I scratch it and he tried to bite me and I pulled his hair, but he put the two hands together and I don’t know, he closed my neck completely, he no leave me chance to talk he don’t know me”. I: “What are you feeling at this time, your emotions..?” P: “Panic, panic, and is as if he’s that happened if..at first I try I can not screaming, but maybe I can talk to him because I am ready for that, talk and maybe he won’t rape me or whatever that’s fine, he no let me, he no let me, he ...was very scared, very scared…” I: “The face on the TV resembled him in some ways in the nightmare...?” P: “Yes, um hum, um hum..” I: “What was the parallel?” P: “The eyes, because I see that his eyes are completely inhuman, evil, mean, he no listen he no see...” I: “What were his eyes like?” P: “I cannot give you the color but they look in’ at me straight and he put these lips like animal like fear of like filthy little teeth pretty mean, but he no know me, he never know what I maybe I am old or what, he was very good looking guy, strong, strong make me feel very scare, I think if he’s jumping again and again and again and before night I think that he’s coming maybe person is closest is there. Living Images in PTSD 11

I: “And you’ve had some art work as part of your therapy drawing the images of what happened and also what was in your dreams and I wonder if we could have you look at this, look at this this morning and tell us what you’re seeing in this art work now.” P: “I see my I see me looking my hand I don’t think I don’t thinking I have a cleaning hands and I have blood in my hand.” I: “Now what is this up here (pointing)?” P: “He’s there he still looks at me, he's evil eyes and his blood and he only like animals and sex or something sick.” I: “And when you woke up there was blood on your hand?” P: “Yea, it was in the bed and the floor, I don’t know what happened, I don’t know, I don’t want to know exactly I may be my mind don’t want it, want..” I: “So, in a way, it’s hard for you really to accept what happened or know even though...?” P : “Probably is that because is like blocking there and I don’t want it thinking I don’t want it...” I : “Too painful.” P : “Shame to go through that... the people don’t listen, they only look at me, look at me, maybe that’s fault or something and they say I am OK, I am beautiful inside, they don’t know me inside, they no care what is inside.” I: “You have love inside. These eyes what do they represent?” P: “The people look at me, but they don't have mouth, they don’t have ears, they don’t listen, they don’t see anything, especially along with check and your light, animal in cage or somehow different kind of person - oh look at what happened to her, they can know what happened to me, it can happen to everyone, everyone.” I: “I would like to continue the video and move on to some other images that you had seen. Do you remember what you saw when you saw when you looked at this particular image?” (showing image 30). P: “ This is something meaning there, they, they magic message or something wrong to the person.” I: “Something wrong to the person, such as what?” 12 Cassell et al

P : "Yes”. I: “OK, how about this one?” (Image 31) P: “That’s like some print, animal print, something wrong either. I don’t like him, I don’t remember exactly what I saw the first time but now I saw like some animal was close remind me some animal was close.” I: “And this man who attacked you was like an animal, right?” P: “Completely, irrational thing, I can not tell like animal, animals are OK, he’s irrational thing, you know.” I: “How about this one?” (Image 32) P: “I don’t like it, things are being shown too much, you can not be definite, there’s something hiding but this some kind of sacrifice or something gross inside.” I: “And this one?” P: “That’s maybe its inside me.” I: “Inside you, what do you mean?” P: “The light is inside, something inside the light, is maybe it’s inside me, some lights coming.” I: “So that’s a good feeling?” P: “Yea, the light.” I: “Good, so you know there’s goodness inside you inspite of the horror of what happened. And this one ?” (Image 33) P: “I like that one, I think too is something inside me.” I: “Something inside you?” P: “Inside me, inside me.” I: “And how does it make you feel?” P: “That’s OK. I wish the peoples could see the inside me.” I: “So there’s goodness inside still, good.” P: “Some part they can not touch.” Living Images in PTSD 13

I: “How about this one?” (Image 34) P: “This - no I don’t like it much as the other one.” I: “What does this remind you of?” (Image 35) P: “It’s strong, strong person - it’s something that squishing something.” I: “Does that remind you of the rape - in what way?” P: “Maybe, he’s very strong and he’s squishing something he don’t know squishing it destroys something. This is like something magic the things we don’t want to know as good or something.” I: “You don’t want to know?” P: “No, the evil side inside something like that.” I: “Do you feel you have a evil side inside you?” P: “I don’t think so, I don’t think so, I have a good body, me because anytime I feel good about other people.” I: “You do and you’re a good person.” P: “Maybe that’s the reason that he tried to attack me because I am not a fancy person.” I: “When we talked before you did feel that, somehow, that the violence that you showed to him and scratching his eye made you evil, can you share that?” P: “Yea, is when you find something evil in you and it scared you having, when you can hear somebody really with your hands, except all you discover and feel is scared about it. I don’t know, I can’t handle things like that - what is my reaction next one, I know that I talk with, when I know the situation.” I: “What you did was perfectly natural and normal to defend yourself, and it’s important that you don’t feel guilty about him.” P: “But, for me to believe it, is still wrong, we can’t talk the most the time and he no give me chance to talk.” I: “Yes, yes. We are going to look at some more images. Here, you had another dream. Can you tell the dream of when it was you saw him directly in the dream, what was that dream?” P: “I have many dreams now..last night I had another ones and another ones. I 14 Cassell et al

was somewhere anytime I saw him jumping me - any door was open - any man I cleaning in some moments changed and be that guy. I: “Let’s look at this image if we could and what do you see there?” P: “I saw the woman part is forming inside and devour him.” I: “How do you feel when see that woman’s part?” P: “Sad, sad.” I: “Why do you feel sad?” P: “Because they thinking is something wrong or they can hear it and make damage in there and that’s the thing.” I: “And how about this, what do you see?” (Image 36) P: “I see somebody’s womb, of women part, the woman is woman is innocent.” I: “And how do you feel - see that?” P: “Too bad, too bad, because the women part does no forget this something beautiful – this we have kids.” I: “It’s a wonderful part.” P: “And is always a pleasure is something you can give when you love.” I: “What about this?” (Image 37) P: “ This is inside a woman from the bottom you see.” I: “And you felt upset looking at that in what way?” P: I don’t think they can see that this pretty private - that’s I don’t like to see pictures like that...Its like a fire inside you ?" I: “What way has your pelvis been hurting you?” P: “Because that it is for something dirty, for something wrong and there’s not that way-there’s not that way.” I: “And in what way have you had physical pain?” P: “Is pain, is pain, is physical pain. I have pain in my ovaries and my part - I have pain - is painful things like that happen, he hurt me, he hurt me.” I: “Let’s come back to your dreams. What way did you see things in the video Living Images in PTSD 15

that reminded you of some of the horrible dreams?” P: “Exactly, I don’t know. I find parts I saw in my dreams is parts I saw in the video I know already.” I: “Yes.” P: “And in some way, they are familiar to me and I associate with the like symbols around my dreams and some part, they are in there.” I: “So, they resemble the images in the dreams. What about the emotions that you felt with the video compared to the horrible emotions in your nightmares?” P: “Well, it’s like you find somebody know what happened, like somebody already know what happened and I can say that one remind me that and that, it’s like put together like TV. Oh, somebody know somebody all ready was in my dream and know what’s going on.” I: “Yes.” P: “It’s some kind of the answer and it’s some way to share what happened because knows is true.” I: “It helps, it helps.” P: “Yea, it helps a lot, it help me a lot.” I: “Because it’s hard to put it into words, would you like to share one of your dreams that you had reflecting the images of the sexual assault with the perpetrator?” P: “Yea, I want it, I really want I write it this morning what I had last night and the way I writing is...” I: “OK.” P: “They tell me to show to looking at many, many men’s was many and all looked the same I need to chose what who was any looked the same, but in some way I know what was and the people working with me don’t pay attention when I show and say this is, this is the guy they was walking, screaming, and laughing nobody pay attention when I say this the guy, this the guy and when they told me it’s time to go I looking and the guy was not there anymore, but then the bunch they all looks alike and I thinking that one, that one, but nobody listen. They told me you do not find him, hat’s fine, let’s go.” I: “And how did you feel in your dream when they didn’t listen?” 16 Cassell et al

P: “Yes, that happened, that happened that’s the truth - nobody want a know who really who was, nobody care, that’s thinking, Oh, OK, you be good, forget about it - and then the men don’t know what big damage the cows and nobody care, we need to be ready for for listen to other person and that is case.” I: “What would you.. is there more to your dream?” P: “I guess there’s something more, when everybody goes start to go and start to walking away, he come and he jump on me and start attacking me again and I - I cannot scream, and I cannot say anything, and they go, they don’t woke up and back to see me, nobody back to see me and he squishing, squishing, I wake up and I have terrible headache last night and sway.” I: “It’s horrible.” P: “Very bad, I call the lady and say can you stay a little bit with me and she told me why you no come with me? And I sit outside for a little while and I back to sleep.” I: “And you had this horrible experience in 1984?” P: “Yes.” I: “What way do the images in the video and in your current nightmares reflect some of the old terrible images in 1984 ?” P: “In especially the - I told you the evil was there - this remind me the same way his eyes looking at me, his, in the same the people don’t listen and don’t believe it - everybody tell me now may be you enjoy what is that! What folly is that ?” I: “It’s outrageous!” P: “It is something, there’s no assault with the physical is the force involving, not exactly the physical go, the scratch go, but who describing my life and feelings and soul go ?” I: “After the first episode in 1984 how long did you have terrible nightmares?” P: “I think to now.” I: “Until now?” P: “And in some woman’s, is like flash back - they show again the guy or show some - some part of that nightmare, many times I feel when I meet somebody I feel the same fears, it’s again. I think he never go, this forever is something you can never have a life.” I: “Thank you very much for sharing.” Living Images in PTSD 17

Interviewer’s Comments Perhaps it might be helpful to consider some additional information about the interview. Initially, it began with a detailed inquiry of responses to her favourite image which was seen to represent “ a happy family”. Starting with this one reduced test anxiety and the associated stress of being on camera in a commercial television studio. Her associations to the “happy family” image led her immediately to speak about a meaningful love relationship with her father. This provided important information concerning her internalized positive image of men. Without this developmental background, it would not have been possible for a male interviewer to effectively build rapport in an interview. This trust was enlarged upon in the second portion of the television studio interview by repeating the detailed inquiry with a female interviewer, speaking her native tongue. The emotional quality of the interview changed dramatically when the detailed inquiry focused on obtaining free associations to the most threatening inkblot. After the initial viewing in the clinic, she had indicated that this inkblot reminded her of her perpetrator and her PTSD dreams. Her associations illustrate the close parallel between the inkblot imagery (Inkblot Imagery or “II”), her conscious recollections of the visual reality at the time of the trauma (Memory Images or “MI”), and the terrible images in her dreams (dream imagery or “DI”). Apart from the emotional discomfort related to the MI and DI, that she was greatly distressed by the perception that people didn’t listen to her complaints of suffering. Frequently, rape victims are further traumatized by lack of understanding in law enforcement officials or others who should be more supportive. It may be recollected as well, that images of the perpetrator’s evil eyes haunted her. The changes in her own body image (BI) were also dramatic. These were reflected in her vivid art work illustrating “blood on her hand” and” shame”. The overall change in her BI was that she felt “very dirty” and obsessively tried to wash the olfactory sensations away. In the second drawing, the emphasis on eyes signified her paranoid fears that people ”look at” her without sufficient emotional support or understanding. The shame is augmented by those who erroneously imply that such a victim “enjoyed” the sexual assault. Next, consideration might be given to the phenomenologic observation that the inkblots were able to assist her in communicating about her positive sense of spirituality within her BI. This was symbolized in her reference to the “light emanating from within. The video also enabled the interviewer to 18 Cassell et al

begin cognitive therapy correcting her guilty thinking that she had “evil within”, because of her aggressive attempts to defend herself. The final blots more closely include anatomical structure denoting the female reproductive system, enabling the expression of her sadness concerning loss in this respect. Similarly, they facilitated her communication about the changes in her BI secondary to the pelvic pain experienced during the violent assault. Finally this projective interview permitted an examination of flashback imagery (“FI”) from an assault years earlier. The in depth treatment plan involved the therapeutic processing both of her recent PTSD sexual assault memories and the long term ones. Discussion Case histories were presented illustrating how women suffering from PTSD secondary to sexual assault were interviewed with the aide of Living Images. This video projective technique accessed traumatic memories and painful emotions. It provided a therapeutic opportunity for the expression of the terrifying DI and FI imagery. When combined with art therapy, Living Images was able to effectively complement both the assessment and therapeutic processes. It facilitated cathartic emotional release, as well as clarifying disturbed imagery, body perceptual problems, cognitive confusion, etc. Apart from the above applications , much quantitative research work needs to be done - especially in association with established multimethod assessment procedures. For example, studies need to be completed by behavioral scientists in the development of psychometric scales for statistical studies. As a starting point, these could address the issue of “diagnostic utility”- the extent to which a particular test index can accurately predict that a person belongs to or does not belong to a specified category (Van der Kock, McFarlane and Weisaeth, 1996). The video system needs to be compared with existing structured and semistructured diagnostic interviews, such as the Structured Clinical Interview for DSM-III-R (Spitzer, Williams, Gibbon and First, 1990), The Structured Interview for PTSD ( Davidson, Smith and Kudler, 1989), The PTSD Interview (Watson, Juba, Manifold, Kucula and Anderson, 1991). The same applies to the need to correlate it with self-report PTSD checklists such as the PTSD Checklist (Weathers, List ,Herman, Huska and Keane, 1993), the PTSD Symptom Scale Self-Report (Foa et al, 1993), the Dutch PTSD scale (Hovens et al, 1993), etc. Until such comparisons are made, it is essential to be prudent regarding the video techniques overall diagnostic validity. Living Images in PTSD 19

In looking to the future, brief consideration might be given concerning how such inkblot procedures may be aides to therapy and clinical investigation. Of the multitude of modern therapy techniques, this approach is particularly relevant in the use of EMDR in treating PTSD. This procedure was originally developed by Shapiro (Shapiro, 1995).It is more based upon body oriented techniques and sharply differs from most traditional language dependent therapies. EMDR instructions ask the victim to focus on the body and conjure up traumatic images, while the therapist alters sensory input by guiding eye movements and stimulating sensory input (e.g. through touch, sound stimulation etc.). Investigators in this field have recently accumulated a body of data which may enrich existing inkblot interpretation theory. These stem from both animal stress studies and human research with victims of PTSD. In the review of the extensive literature on the effects of stress on experimental animals, it has been observed by Van der Kolk, Mc Farlane and Weisaeth in their insightful book, Traumatic Stress (1996) that traumatic sensations may then be revived, not in the distorted fashion of ordinary recall, affect states, somatic sensations, or visual images (‘nightmares’ or’ flashbacks’) that are timeless and unmodified by subsequent experience. The concept of indelible subcortical emotional responses, held in check to varying degrees by cortical and septo-hippocampal activity, has led to the speculation that delayed onset PTSD may be the expression of subcortically mediated emotional responses that escape cortical (and possibly hippocampal) inhibitory control (Van der Kolk and Van der Hart, 1991; Pitman et al., 1993;Charney, Deutch, Krystal, Southwick and Davis, 1993; Shalev et, al, 1992). The related human neurologic studies have uncovered specific abnormalities of the limbic system in PTSD. For example, clinical investigations have found that people with PTSD have decreased hippocampal volume - part of the brain concerned with memory. Particularly relevant to the first clinical case presented above is a study by Stein et al (1994) indicating a 7% reduction in hippocampus volume in women who had repeated childhood sexual abuse. In a different part of their book, Traumatic Stress, the above authors summarized their original experiments concerning the activation of PTSD symptoms by reading transcripts of the original trauma, while measuring with positron-emission tomography. They found that “ subjects demonstrated heightened activity only in the right hemisphere – in the paralimbic belt, parts of the limbic system connected to the amygdala, the insular cortex, the posterior orbital-frontal cortex, 20 Cassell et al

the anterior cingulate cortex and the anterior temporal cortex. Activation of these structures was accompanied by activation in the right visual cortex, reflecting the visual experience of their traumas. Significant (by its absence) was the observation that Brocas’s area, the part of the left hemisphere responsible for translating personal experiences into communicable language, showed a significant decrease in oxygen utilization during the exposure to traumatic reminders. This probably means that during activation of a traumatic memory, the brain is “having” its experience. The person may feel, see or hear the sensory elements of the traumatic experience. He or she may be physiologically prevented from translating this experience into communicable language. When PTSD victims are having their traumatic recall, they may suffer from speechless terror in which they may be, literally, out of touch with their feelings. These impressions are consistent with Ledoux’s (1992) hypothesis that emotional memories can be established without any conscious evaluation of incoming information by the neocortex, and that a high degree of activation of the amydla and related structures can facilitate the generation of emotional responses based upon fragments of information, rather than full- blown perceptions of objects and events to a particular stimulus.” These observations may have relevance to those who employ projective inkblot assessment. Hermann Rorschach proposed that certain projected anatomical responses in his inkblot series reflected the subject’s awareness of kinesthetic sensations. Consistent with this thesis, two of the SIS inkblots (17A & 18A) were originally designed with heart-like visual connotations. This was done to enable the study of the psychophysiologic relationship between cardiac consciousness and sensory feedback of cardiovascular arousal (Cassell, 1969). It was expected that stress- induced, increased heart rate would lead to increased sensory feedback from the cardiac region, and therefore, a tendency to project increased numbers of anatomical responses denoting cardiac consciousness. In one of our earlier project (as expected), it was found that individuals suffering from cardiac symptoms (e.g. palpitations, pain, etc.) projected an increased number of heart responses. By contrast, there was another group who were symptomatically highly aware of their hearts, yet who avoided such cardiac connotations in the newly created somatic inkblots. Originally, Repressionsensitization theory (Byrne, 1964) was considered relevant in attempting to explain these paradoxical findings. The insights concerning mind-body relationships reviewed in Van der Kolk, Mcfarlane and Weiseath’s book would appear to add a central nervous system missing link to the understanding of such paradoxical mind-body relationships. It now seems pertinent to hypothesize that some projected anatomical responses Living Images in PTSD 21

may reflect right brain activity in the limbic system associated with “brain pictures”, occurring at moments of previous stress. Given such conceptualizations and those of others, it is understandable how these may tend to be far removed from left brain cognitive function and consequently, distant from conscious awareness. There is much clinical evidence to indicate that inkblots can access right brain memories beyond the realm of cognition and language. Content analysis of projected imagery frequently symbolizes a particular trauma, but the victim cannot explain or recall how it relates to long forgotten past traumatic episodes. An example observed a number of years ago by one of the authors (Cassell, 1980) involves a gynecological patient suffering from cancer of the cervix. She was sufficiently well informed prognostically to understand that there was a high possibility of spread to other pelvic structures. However, in traditional medical interviews, she denied this implied fear. It was remarkable that this life threatening traumatic experience was blocked from consciousness. She repeatedly refused the interpretation that her projected anatomical Rorschach response of a “pelvis being eaten by bugs” reflected her fear that the cancer had spread. The detailed inkblot inquiry, like traditional psychotherapy, involved verbal communication, a left brain activity. Over the ensuing years, there have been many such examples observed using the SIS inkblots. For example, one case presented last year in this journal (Cassell and Dubey, 1997), involved a woman who, in early childhood, witnessed her little brother being killed by sled dogs, when her language and cognitive skills were immature. The viewing of the SIS video at bedtime triggered the emergence of PTSD “nightmares”, encapsulating images and emotions of this long forgotten trauma. These memories were apparently indelibly imprinted on her right hippocampus, visual cortex and related areas. It appears that their release was triggered by viewing the SIS video, first surfacing through dreams. Such hypotheses need to be investigated by research scientists examining both right-left differences in peripheral feedback of autonomic nervous system arousal as well as concurrent central nervous system activity during experimental inkblot activation of PTSD memories. A multidimensional assessment of body awareness appears to afford the most promise in the envisioned projects. This need is based upon the complexity of the relationships and previous earlier work with a body focus measure of indicating that measures of right versus left body awareness change during pharmacologic (Cassell and Hemingway, 1970) and physiologic arousal (Fisher, 1960, 1962). 22 Cassell et al

A final consideration needs to be addressed for both investigators and clinicians who plan to employ these inkblot stimulation techniques. Experience indicates the need for words of caution. From the standpoint of the traumatized individual, productively activating such imagery with inkblots can sometimes evoke strong emotions. Victims of severe stress need to be warned about the risks/ benefits. This approach needs to be restricted in borderline or potentially psychotic individuals. In a related fashion, clinical investigators and therapists need to be advised about the possibility of experiencing potentially toxic empathetic pain with the SIS and Living Images projective procedures. On the positive side, the technology of inkblot video has great pulling power for traumatic imagery, and consequently, enhanced therapeutic potential. On the negative side, it more directly exposes caring professionals to “compassion fatigue” or “burn out”. This psychologically hazardous exposure to traumatic images may be historically compared to radiation- induced illnesses, acquired naively by unshielded medical researchers at the turn of this century. Given these precautions, it appears that Living Images deserve strong consideration for all professionals working with women suffering from the adverse effects of traumatic life events. References Adamson, J.D., Greengrass R.and Martin R.M (1977) Cassell’s Anatomical Pictures: Responses by Groups of Hospitalized Inpatients. British J. of Projective Psychology and Personality Study, 22:27-35. Allen, S. (1994) Psychological assessment of post-traumatic stress disorder. Psy. Clinics of North America, 17, 327-349. American Psychiatric Association, (1994), Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington, D.C. Bailey, C.J. and Murnstein, B.I. (1996) Paranoia Assessment with the SIS-II: In a college Student Sample. SIS J. Proj. Psy. & Mental Health, 3,2 : 109-122. Barrett, D., Editor (1996) Trauma and Dreams, Cambridge and London, Harvard University Press. Bellamy, E. N. (1995) Hospitalized Suicidal Patients and the Somatic Video Procedure : a Descriptive Study, SIS J. Proj. Psy & Ment. Health, 2;85-91. Benson, H. and Stuart, E.M. (1992) The Wellness Book. Fireside Simon and Schuster New York N.Y., U.S.A. Benson, H. (1996) Timeless Healing. Fireside Simon and Schuster, New York N.Y. Brady, D. (1995) A Study of Somatic Inkblot Series : Application in Medical Setting, SIS J. Proj. Psy. & Mental Health, 2:129-134. Living Images in PTSD 23

Berk, E., Black, J., Locastro, J., Wickis, J., Simpson, T., Keane, T. and Penk, W. (1989) Traumatogenicity: Effects of self-reported noncombatat trauma on MMPIs of male Vietnam combat and noncombat veterans treated for substance abuse. Journal of Clinical Psychology, 45 704-708. Cassell, W.A. (1965) Body Perception and Symptom Localization, Psychosomatic Medicine, 27:171-176. Cassell, W.A. (1972) Individual Differences in Somatic Perception. Advances in Psychosomatic Medicine, 8:86-104. Cassell, W.A. (1977) Desensitization Therapy for Body Image Anxiety. Canadian Psychiatric Association Jour. 22:239-242. Cassell, W.A . (1979) Anatomical Rorschach Responses and Death Symbolism. British Journal of Projective Tech. 24: 7-16. Cassell, W.A. (1980) Body Symbolism. Aurora Press Anchorage Alaska. Cassell, W.A. (1980) Body Awareness and Delusions Involving Sexual Organs. American Journal of Psychoanalysis, 40:125-135. Cassell, W.A. (1984) Computerized Projective Testing as an Aide in Medical Diagnosis. Alaska Medicine, 26:1-9, 1984. Cassell, W.A. (1991) Art Therapy Using the SIS-II Video. Japanese Bulletin of Arts Therapy, 22:131-135. Cassell, W.A. (1995) Somatic Inkblot Series - Video Case Report and Discussion, SIS J. Proj Psy. & Mental Health, 2:3-18. Cassell, W.A. and Dubey, B.L. (1996); The Use of Rorschach and SIS in Releasing Somatized Grief. SIS J. Proj. Psy & Ment. Health 3:3-32. Cassell W.A. and Dubey B.L. (1997) Therapeutic Dream Stimulation With the Somatic Inkblot Series – Video. SIS J. Proj. Psy & Ment. Health, 4: 3-23. Crick, E. and Mitchison, G. (1983) The Function of Dream Sleep. Nature, 304:111-114. Dosajh, N. L., (1996) Editorial. SIS J. Proj. Psy. & Ment. Health 3;2:89-90. Dubey, B.L. and Cassell, W.A. (1993); Some Experience with the Somatic Inkblot Series, British J., Proj. Tech., 38;19-41. Gallop Institute: Religion in America - 50 Years. Princeton University, N .J. Princeton Research Center, 1995. Gartner, J., Larson D.B and Allen G.D. (1991) Religious Commitment and Mental Health: A Review of the Empirical Literature. J. Psychology and Theology. 19;6-25 Gould, J.R., Prentice,N.M., and Inslie, R.C. (1996) The Splitting Index: Construction of a Scale Measuring the Defense Mechanism of Splitting. J. of Personality Assessment, 66;.2, 414-430. Hollender, M.H. and Cassell, W.A. (1965) Psychological Problems Associated With Hirsutism. International Psychiatric Clinics, 3:2-10. Kendler, K.S., Gardner, C.O. and Prescott, C.A. (1997) Religion, Psychopathology and Substance 24 Cassell et al

Use and Abuse: A Multimeasure, Genetic - Epidemiologic Study. The American J. of Psy., 154: 3:322-329. Mukhopadhyay A., Banerjee S. and Mitra G. (1996) A Comprehensive Profile of Male Drug Addicts. J. Proj. Psy. & Ment. Health, 3.1:33-41. Pelcovitz, D., Van Der Volk, B., Roth, S., Mandel, F., Kaplan, S. and Resick, P. (1997) Development of a Criteria Set and a Structured Interview for Disorders of Extreme Stress (SIDES). J. of Traumatic Stress, 10.1:13-16. Pershad, D. and Dubey, B.L .(1994) Reliability and Validity of the Somatic Inkblot Series in India. Rathee, S.P. ,Goel, D.S., Chawla, M., L., Saldanha, D. and Dubey, B.L. (1994) A Study of Somatic Inkblot Series -I in Coronary Cases. SIS J. Proj. Psy. & Ment. Health 1.1:51-65 Rathee, S.P., Pande, V. and Singh, A. (1995) Diagnostic Efficacy of Somatic Inkblot Series-II among Psychiatric Patients of Armed Forces: A Preliminary Study. SIS J. Proj. Psy. & Ment. Health, 2.1:53-61. Shin, L.M., Kosslyn, S.M., McNally, R.J., Alpert, N.M., Thompson, W.L., Rauch, S.L., Macklin, M.L., and Pitman, R.K. (1997) Visual Imagery and Perception in Posttraumatic Stress Disorder - A Positive Emission Tomographic Investigation. Archives of General Psychiatry, 54:233-241. Singh, A.R., Sengar K.S., Ahmed, Banerjee, K.R. and Shukla T.R. (1996) Efficacy of a New Inkblot Technique in Differentiating Manics, Alcohol Dependants and Normals SIS J. of Proj. Psy. & Ment Health. 3.1:77-83. Savage, G. (1995) The Use of Hypnosis in the Treatment of Complicated Bereavement. SIS J. Proj. Psy. & Ment. Health, 2 ;29-40. Spitzer, R.L., Williams, ,J.B., Gibbon, M. and First, M.B. (1900). Structured Clinical Interview for DSM-III-R-Patient edition (SCID-P). New York: Biometric Research Department, New York State Psychiatric Institute. Van der Kolk,B.A., McFarlane, A.C. and Weisaeth, L. (1996) Traumatic Stress. The Guilford Press, New York, N.Y. Verma, S.K., Pershad, D. and Nehra R. (1994) Cross-Validation of SIS-II in Psychiatric Population. SIS J. Proj. Psy. & Ment. Health. 1.1:3-15. Verma, S.K. (1995) Reliability and Validity of Somatic Inkblot Test. SIS J. Proj. Psy. & Ment. Health 2.1:67-72. Verma, S.K. (1997) Editorial :A Secret Message and a Challenge, SIS J. Proj. Psy. & Ment. Health, 4-1:1-2. This journal’s Living Image response protocol follows : Image 1 : A Chinese guy with a fur ruff...scary...sinister...a wolf. Living Images in PTSD 25

Image 2 : Solar system...outer space...peaceful. Image 3 : It looks like the uterus and fallopian tubes. Image 4 : A pizza being sliced...hot. Image 5 : A bird flying...freedom...light. Image 6 : A fly...creepy...itchy...I am glad that it is going away. Image 7 : A valentine heart beating...its going from good to bad like a telltale heart - like in Poe. Image 8 : A spanish guy flamenco dancing - chacha...saucy. Image 9 : Two guys about to duel...it makes me feel sad. Image 10 : Siamese twins trying to separate because they are mad at each other...a shame. Image 11 : Blurry twins trying to separate...why? Image 12 : male/female dancing...good times. Image 13 : Pushups...I hated gym. Image 14 : A goofy looking guy with a mustache...silly. Image 15 : A family...mum...dad...and child...security. Image 16 : A scared family trying to hang on to each other ...windy...don’t let go. Image 17 : A loving close family...kids look up to parents...it feels good...safe. Image 18 : A doctor examining a patient with head trauma and a really bad headache...alarm! Image 19 : Death...two bodies and undertaker...depressed. Image 20 : An adult kissing a child...a “booboo”.. to make it better. Image 21 : Horses...mum and dad...cold. Image 22 : An Easter bunny and a skull...confusion...a weird combination. Image 23 : A lady and kids - teacher in a preschool...finger-painting. Image 24 : A college professor in robes lecturing...boring. Image 25 : Gloom...a mean judge...two scared people...don’t like him. Image 26 : A lady winking...flirting...smelling flowers...happy...it looks like me. Image 27 : A doctor symbol...(staff of life?) Image 28 : A flower...pollen in the middle glowing...calm. Image 29 : A creepy face...the bottom teeth showing...trying to scare me. Image 30 : A red haired woman - brain - ideas - puzzled. 26 Cassell et al

Image 31 : A snowman juggling scarves - amusing. Image 32 : Ninja turtle ready to fight - it’s hostile.. I’m not nervous. Image 33 : Hard to make out...a cat face... hate cats. Image 34 : Gut with a big nose- looking out from behind a curtain - strange. Image 35 : Two skydivers holding hands as they free fall...fun...cool...freedom. Image 36 : St. Bernard dog...love able...hug me...friendly. Image 37 : Dumb dog - hole in head - no face/personality...feel bad. Image 38 : Waitress bringing drink - big drink - glad to see her. Image 39 : A hard-boiled egg between two fat bellies. Image 40 : Baseball hat - really hot day -bald under hat. Case II Image 1 : Musical instrument -haunting. Image 2 : Galaxy...awesome...serene...dynamic Image 3 : Face of insect - curious. Image 4 : Nuclear explosion...radiant... symmetrical. Image 5 : Bird in flight...soaring...powerful. Image 6 : Creatures...inviting...loving. Image 7 : Pulsating heart...warmth. Image 8 : Animated being...caring, joyous, alive. Image 9 : Twins...potbellied - union wholeness. Image 10 : Twins...Siamese - conflict...trapped...angry. Image 11 : Twins...the fuzziness represents effort at relationships. Image 12 : Male/female - marriage...love...union. Image 13 : Vision...iris (i.e. of eye)..- clarity...searching. Image 14 : Carton cat...fuzzy...funny. Image 15 : Antennas...receptive...informed. Image 16 : Sea Anemones - receptive...informed - lyrical.. light. Image 17 : Parents/children ...family -touching. Image 18 : Solar system. Image 19 : Trees...forest - connected...communication. Image 20 : Drinking from chalice - Holy. Living Images in PTSD 27

Image 21 : Donkeys/lamb - differences...peace versus war. Image 22 : Rabbit/egg. Image 23 : Ocean floor -alien...soothing...eternal. Image 24 : Angel - protecting...nurturing. Image 25 : Confusion - depression...sad...bold. Image 26 : Lady with flower - energetic...thoughtful. Image 27 : Masked vertebrae...uplifting...straight . Image 28 : Clouds with lightning. Image 29 : Butterfly - serene. Image 30 : Angel - reverent. Image 31 : Spider - repulsive. Image 32 : Fish camouflaged - secure and natural. Image 33 : Flowers at sunset - peaceful...vibrant...alive. Image 34 : Cells dividing - busy...important...essential. Image 35 : Egg...fertilized - protected. Image 36 : Symbol/character - continuity...productivity. Image 37 : Female reproductive organs - healthy...glowing. Image 38 : Candle with flower - warm...serene. Image 39 : Eyes - startled...frightened. Image 40 : Egg growing - diversity...cycles...life. Addendum In order to encourage students to become involved with the SIS and Living Images projective techniques, the following contest has been established. Each publication of this journal will present the responses of two particular cases to be compared for content analysis assessment and treatment plan development. Students who wish to compete for a prize of $250.00 may write the editor for details of the clinical case histories. Essays will be judged by the extent that they meaningfully integrate inkblot responses with diagnosis and therapy needs. The winner will be announced in the following issue of the journal. The Alaska SIS corporation acknowledges the kind financial support of a grant from Eli Lilly. 28 Cassell et al

A Comparative Study of Personality Problems of Russian and American Female Adolescents Anatoly B. Khromov, Wilfred A. Cassell and B.L. Dubey Somatic Inkblot Series- Card form (Cassell, 1980) was administered to 91 Russian female adolescents in the age group of 18 to 22 years and to a comparable group of 168 Americans in the age range of 18 to 23 years. Examples of negative sexual responses are described on the 20 SIS cards. Americans were more direct in their answers, especially when the stimulus cards/images looked like sexual organs. The Russian adolescents were more conscious about supervising the statements, marking their statements with desirable and acceptable adjuncts. Russian gave fewer pathological anatomy responses, heart responses, rejection responses but greater number of paranoid, somatic repression scale, movement, anxiety threat, hostility, depressive and sexual responses, as compared to American adolescent females. The Somatic Inkblot Series is the latest inkblot series that has been developed (Cassell, 1980). Somatic imagery theory proposes that everyone has a unique and highly personalized system of attitudes, both conscious and unconscious, that is projected on to the body concept as a special entity. These interact with feedback source and internal sensations. SIS- Manual has been translated and adapted in Russian by Khromov (unpublished manuscript 1998). Cross- cultural comparisons have been made from different parts of the world but little is published on Russian subjects. Personality problems of Russian and American female adolescents were studied with the help of SIS cards in the present study. Sample 91 Russian female adolescents- 18 to 22 years old and 168 comparable (age, sex) American females – 18 to 23 years of age. Tool SIS – cards form (Cassell 1980) Results American girls were direct in their answers, especially when the stimulus looked like sexual organs. The Russian girls were more conscious about supervising the statements, masking their statements with desirable and acceptable adjuncts. Anatoly. B. Khromov, N6 Mier. VI Apt. 163, Kurgan – 640023 (Russia) Wilfred A. Cassell, SIS Center, 4105 Tudor Center Drive, Anchorage, AK 99508, (USA) & B.L. Dubey, Ph.D., SIS Center India, PO Box 1107, Sector 15 Post Office, Chandigarh-160015 India. (This paper was Presented at the 24th International Congress of Applied Psychology, San Francisco, August 9- 14, 1998).

30 Khromov et al Table 1 Comparative Data : American and Russian Subjects A. Pathological Anatomy Scale (PAS) Scores Number of responses in percentages Female 18-23 0 Americans 10.8 5.4 21.6 8.1 6.2 21.6 10.8 5.5 Russians 5.5 13.1 4.4 8.8 15.4 17.6 12.1 13.2 5.5 4.4 B. Paranoia Scale (P) scores Number of responses in percentages Female 18-23 Americans 59.5 21.6 8.1 5.4 2.7 2.7 Russians 37.4 26.4 7.7 12.1 8.8 1.1 2.2 1.1 2.2 1.1 C. Heart responses Number of responses in percentages Female 18-23 Americans 24.3 18.9 24.3 8.1 16.2 8.1 Russians 29.7 32.9 17.7 13.2 4.4 2.2 D. Somatic Repression Scale (SRS) Number of responses in percentages Female 18-23 Americans 5.3 15.8 28.9 23.7 18.4 5.3 2.6 Russians 15.4 1.1 9.9 27.5 19.8 16.5 7.7 2.2 E. Movement Responses (MR) Number of responses in percentages Female 18-23 Americans 35.1 32.4 32.4 Russians 12.1 6.6 14.3 14.3 17.6 10.9 9.9 5.5 6.6 3.3 F. Rejection Responses Number of responses in percentages Female 18-23 Americans 89.2 5.4 2.7 2.7 Russians 31.9 32.6 19.8 8.8 5.5 G. Anxiety- threat Responses (ART) Number of responses in percentages Female 18-23 Americans 40.3 8.1 29.7 5.4 16.2 Russians 12.11 9.8 27.5 18.7 9.9 5.5 3.3 3.33 3.3 H. Hostility Responses (HAS) Number of responses in percentages Female 18-23 Americans 75.0 16.2 3.5 5.3 Russians 34.1 29.7 25.3 7.7 2.2 I. Depressive Response (D) Number of responses in percentages Female 18-23 Americans 91.9 2.2 5.4 Russians 18.1 26.4 19.8 15.4 10.8 4.4 4.4 2.2 1.1 J. Sexual Response Number of responses in percentages Female 18-23 Americans 70.4 21.6 8.1 Russians 13.2 26.4 29.7 17.6 6.6 3.3 2.2 2.2 Examples of the Responses of a young woman with her negative sexual experience on SIS-I are shown in table 1.

Norms on 15 selected SIS Variable are shown in table 2. Table 2 Norms on Russian Female Adolescents SIS Scoring Indices 91 Russian subjects Mean S.D. Total Number of Responses (R) 28.93 9.34 Human Responses (H) 4.84 2.24 Animal Responses (A) 6.05 2.46 Anatomical Responses (At.) 7.97 6.15 Sexuality (Sex) 2.01 1.44 Movement (M) 4.04 2.90 Most Typical Responses(MT) 2.41 1.29 Atypical Responses (AT) 7.19 3.32 Positive Emotions, Optimism (op) 2.39 1.86 Heart Responses 1.36 1.28 Somatic Repression Scale (SRS) 3.26 1.84 Pathological Anatomy Scale (PAS) 4.65 2.55 Hostility and Aggression Scale (HAS) 1.19 1.12 Depression 2.09 1.79 Need for appointment - Paranoia Scale (P) 1.70 2.17 The examples of the responses of a young woman with her negative sexual experience on SIS are shown in table 2 and discussed ahead. Responses to card 1 – Sofa on two small legs, near home shoes lay. The answer is not typical. “Sofa on two small legs” – symbol of instability, of unusualness of a situation. Responses to card 2 – Wolf catches something, that eagle brings to him. This response there is the context of a frustrative situation, in which there is the aggressive predator (wolf), the second predator (eagle) emphasizes fatal inevitability and doom of a victim. Response to card 3 – Two persons throw stones, catch them and again. In the response a theme of sexual interaction is projected. Response to card 4 – The person wants to jump somewhere, in order to avoid falling of heavy, hanging right above. In this response the desire of a person being tested to leave a usual situation is projected. SIS in Russians & Americans 31

Response to card 5 – Magus, managing a flame. A turtle, with a tail like at fish, floating against current. In this response a frustration motive is reflected. “the turtle floating against current”, is an image the woman, which has confronted with vital problems, “flame” is a man’s symbol. The situation is operated by a man , but the woman resists and tries to take a situation under the control. Response to card 6 – Two graves with on tombstone. Above a head - rest. In the response the destroyed relationship between a man and woman sound like depressive ideas. Response to card 7 – Woman, jumping downwards, (around her fire). An elephant, a trunk of which is in a center of a circle from a fire. In this response there is the image of fall, as the symbol of desire to leave a situation . The sexual painted response. Response to card 8 – Heart in a chest cavity. Two dragons, throwing a flame. Heart in a chest cavity – the typical response. The second response image of men. Response to card 9 – Kidney with stones. A cyclist, going on a bicycle upwards by legs. The first response – anatomical, second – purely sexual. Response to card 10 – The gastrointestinal system of the person (mouth, bowels, stomach, direct bowels). Typical, not remarkable response. Response to card 11 – Gates in the middle of fence. A path, as though conducting to the gates, but suddenly turning off. The sexual response, has a latent depressive content. Response to card 12 – Someone attacks the woman. Depression and fear, contained in this response, are a projection of a problem, caused by negative sexual experience. Response to card 13 – Stabbed in a wall a head of King. It is unusual for this card response, image of a man, having the authority is submitted. Response to card 14 - A crave, in depth of which is a woman. A mirror, in which she is displayed. The woman seems to be blind. And head of the woman is without the face. Depressive content and suppressed anger has been brought on surface through this image. Response to card 15 – Bones of an ancient dinosaurs. The bounded person having enough wigs on his head. In the response a depressive and frustrative state is projected. 32 Khromov et al

Response to card 16 – People, laying on the ground with swords at their backs (dead). Mask with wild brilliant eyes. Small mug of a fox. Two ostriches, have approached close to each other. Closely. At these responses to one stimulus present a depressive content, reflecting mutual relation of two people. Response to card 17 – Black person with a ponytail (bad). The negative relation to a man is emphasized by a designation of colour “black”, and even more amplifies by the characteristic – “bad”. Response to card 18 – Helmet of the knight with horns. In the response there is a determination of aggressiveness of a man, designation of his instrument of aggression “with horns” is once again given. Response to card 19 – Women hold each other by hands and dance. The fact, that in the response an image of two dancing women is submitted, can have sympomatical meaning. It can either projection of homosexual bents, or denying of negative experience of mutual relation with a man. Response to card 20 – Two dancing persons. Two riders, holding each other by hands. Something whole has broken on two sides, and they fall, being separated from each other. In this response two persons, skipping by top, are once again designated, that can be regarded as the sexual response, with depressive motives and motives of being doomed. Russian female adolescents gave fewer pathological anatomy, heart response as well as rejection of images, when compared to American adolescent females. On the other hand, Russians gave greater number of paranoid responses, somatic repression responses, movement responses, anxiety threat responses, hostility responses, depressive and sexual responses – as compared to the American adolescent females. Reference Cassell, W.A. (1980) , The Somatic Inkblot Series (The SIS) – in body symbolism and Somatic Inkblot Series. Khromov, A.B. (1998) unpublished manuscript – translation and adaption of Cassell Book in Russian. Further references can be had from the authors on request. This includes the Russian adaptation of the scales used here and other related details. SIS in Russians & Americans 33

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.net 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.dot.net.in National Psychological Corporation 4/230, Kacherighat, Agra - 282 004 Tel. : 91-562-364926, 350113 F F F ANNOUNCEMENT The Somatic Inkblot Society is a Non-Profit International Organization with headquarters in India. The Indian Govt. has recognized it as a Corporation for Income Tax purposes where relief is given to donators and advertisers under section 80G of Income Tax. In America, a comparable non-profit organization similarly named the Somatic Inkblot Society gives Income Tax relief for residents of the United States. Please help the Society by Donation/Advertisement For it's smooth functioning. President, Somatic Inkblot Society

Some Personality Correlates of Selected SIS Variables : Russian Experiences Anatoly B. Khromov, Wilfred A. Cassell and B. L. Dubey Somatic Inkblot Series card form was administered to 91 Russian female adolescents (age range 18 to 20 years) in addition to some personality questionnaires, general health and psychological measures in order to find out the personality correlates of selected SIS variables. Russians give greater number of movement responses which correlated with high estimation of success in activity; with motivation of achievement and studying ; with independence and assuredness; with low rigidity, hostility, personal anxiety; with high cheerfulness with cooperative type personality. The responses of movement negatively correlated with basic scales of MMPI such as: D, Pd, Pa, Ps & Sc,. A high level of logical thinking was positively correlated with physiological responses and was negatively related with the sexuality. Among the psychological tests, inkblot techniques are the most exciting and significant. Zubin, Eron and Schumer (1965) indicated that the concept of formless stimuli, used in inkblot techniques to stimulate the imagination, can be traced back to Leonardo Da Vinci and Botticelli in the fifteenth century. Baumgarven- Traumer (1942) mentioned that in 1910 in Moscow there appeared an atlas for experimental research on personality, published by a Russian psychologist named Theodere Rybakow who was a tutor at the Moscow University. In the atlas, there was a test consisting of eight inkblots. All of them were asymmetrical. Rybakow with Konard Gehring, his teacher, discovered, while using inkblots displayed on very large sheets of paper at the front of the classroom, that certain children gave very similar responses to a variety of inkblots, even though the images were different in their form and colour. The primary historical period of inkblot use in projective testing began in 1911 with Herman Rorschach’s innovative research on “the interpretation of accidental forms” (1921). At present the inkblot tests are the most favoured (Sundberg, 1961; Dubey 1982), Cassell (1965) initially used inkblots to study awareness, subject’s body perception and somatic symptoms. There are three major standardized tests based on inkblots : 1. The Rorschach Inkblot test, published in 1921; 2. Wayne Holtzman developed the Holtzman Inkblot test to overcome some of the limitations of the Rorschach. Holtzman has clearly emphasized the Anotoly. B. Khromov, N6 Mier. VI Apt. 163, Kurgan – 640023 (Russia) Wilfred A. Cassell, SIS Center, 4105 Tudor Center Drive, Anchorage, AK 99508, (USA) & B.L. Dubey, Ph.D., SIS Center India, PO Box 1107, Sector 15 Post Office, Chandigarh-160015 India.

psychometric approach of his test; 3. The Somatic Inkblot Series (the SIS), initially developed in 1960 by Wilfred A. Cassell specifically to understand the manifestation of problems through somatization, to hear the suffering individual’s “inner cry." Somatic imagery theory proposes that everyone has a unique and highly personalized system of attitudes, both conscious and unconscious, that is projected onto the body concept as a special entity. These interact with feedback sources and internal sensations. Relatively discrete mental representations exist for particular somatic regions which constantly compete for full registration in consciousness. Somatic awareness transiently increases in states of hunger, physical exertion, emotional arousal and sexual excitement. Subsequently, the mental representations in the body fade into the background of consciousness. The SIS provides researchers with a diagnostic aid for body percept assessment to evaluate the depth and significance of somatic symptoms, somatic delusions and sexual dysfunction. While the SIS uses somatic inkblots that involve body and organ imagery, a variety of personal problems and mental disorders have been identified by it also. What the subjects see in ambiguous and semiambiguous inkblots show how they see their life and lifestyle, their adjustments to conflicts, their coping skills and their views of the reality of life. The SIS is a projective test, it is not based on verbal communication, it more effectively penetrates a person’s “outer shell” of defenses and surface behaviors. It directly accesses mental processes. The SIS uses the language of dreams, visual imagery and symbolic thought, the most basic form of thinking and expression. The SIS speaks the language of repression and brings whatever is buried in the mind closer to consciousness, so it is accessible for processing. Roy Schafer, a psychoanalyst, advocated a content analysis approach (Schafer 1954, 1960). More recently, content analysis has been reviewed by Aronow and Reznikoff (1973). This study was inspired by the Cassell’s phrase from his 'Body Symbolism' (1980), that “another area which has considerable potential for future investigation is the study of the relationship between body awareness patterns and personality profiles”. Much of the original research in this field was pioneered by Symour Fisher (1970) who devised a body focus questionnaire by which a subject chose between pairs of body region terms to assess relative body awareness. Fisher 36 Khromov et al

correlated this data with the results of standard personality scales. It was found that the more vivid a woman’s awareness of the heart, the more likely she was to value caring and romantic relationships with others. For men it was found that those with enhanced heart awareness tended to invest more energy in work activities than in leisure and entertainment. Also men with accentuated heart awareness were more involved in religious activities. It is suggested that the Somatic Inkblots might be used in similar mind- body research. If valid, SIS would prove helpful in personality assessment. Tests This correlational study used following tests : 1. The Somatic Inkblots Series (the SIS) – in Body Symbolism and Somatic Inkblot Series. Cassell (1980), translated and adapted by Khromov unpublished (1998). 2. The Holland’s Self Directed Search (SDS, translated and adapted by Khromov 1997). 3. The Five- Factor Personality Questionnaire (FPQ) by Heijiro Tsuji et al 1966), translated by Dostovalov and Khromov and adapted by Khromov 1998. 4. Leary and Coffey "Interpersonal Diagnosis", adapted by Sobchik in Moscow 1990. 5. The MMPI, adapted by Sobchik in Moscow 1990. 6. The Luscher Color Test. New York, 1978 (Based on the text – Basel, 1969), adapted by Khromov 1997. 7. 16PF Questionnaire. 8. Hostility and Aggressiveness Scale (Buss and Durkee). 9. Raven’s Scale (adapted in Russian). 10. Suppos-8. 11. Motivation, Estimation of success, Rigidity. With Likert Scale Questionnaire. 12. The tests of comic phrases. All these scales were adapted in the Russian for use with Russian subjects. Subjects 91 Russian female subjects in the age range of 18-22 years were administered the above mentioned twelve tests. The resulting data were compared to the data obtained from the same type of tests administered on 168 unpaid American SIS in Americans & Russians 37

subjects of the same age group and sex. Results and Interpretation Intercorrelation between the Data of the SIS-I and the Parameters of the Personality Tests A. Total number of responses (R) Factor Test r p Artistic type of the person Holland’s test 0.2839 0.01 Social type of the person Holland’s test 0.2091 0.05 Obedient, timid Leary’s scale 0.2237 0.05 Cooperating conventional Leary’s scale 0.2147 0.05 Feeling of fault Buss and Durkee’s scale 0.2651 0.05 Emotionality FPQ 0.2627 0.05 Playfulness FPQ 0.2291 0.05 Dominance submission FPQ -0.3078 0.01 Understanding FPQ 0.2152 0.05 Deliberateness let-it-be-ness FPQ -0.2334 0.05 Anxious FPQ 0.2206 0.05 Mood fluctuation FPQ 0.3076 0.01 Self- criticism FPQ 0.2588 0.05 Imaginativeness FPQ 0.2141 0.05 Inner sensibility FPQ 0.2537 0.05 Dark Blue colour test Lusher’s Scale 0.2825 0.01 Black colour test Lusher’s Scale -0.2319 0.05 On structured stimulus of the SIS technique the probability of reception of the identical responses of different subjects is higher, than in the Rorschach’s test, as the SIS stimulus has more expressed anatomical structure. In Cassell’s opinion the quantitative index of the responses (R) suggests imaginative capacity and functional intelligence of the subject. Psychiatrically ill patients have a poor imaginative capacity and functional intelligence. In the present research the correlation analysis has displayed, that the person, showing more responses on the projective inkblots of the SIS have the following peculiarities : they concern to the artistic type of the person in Holland’s classification, such people are sensitive, imaginative and more inclined to aesthetic creativity, than to routine work; they are careless, trustful; they are emotional persons with mood fluctuation. These persons are timid and cooperative types (in Leary’s classification). Preference of cooperation to rivalry is the characteristic of such people. These people do not like to dominate, prefer to be submissive, trustful, well understanding 38 Khromov et al

and can display love to others. They are tactful in dialogue and at time get confused. In case of disagreements they are capable to repent for errors and are able to overcome such faults in future. Such people get disturbed easily and are inclined to self- criticism. Basic problem for such persons is instability of emotional sphere, shown in variability of mood. They are not protected, not adapted to vital difficulties and have advanced imagination. They are complicated, original and show variety in intellectual activity. B. Human Responses (H) Factors Tests r p Artistic type of the person Holland’s test 0.2113 0.05 Routine MMPI -0.2360 0.05 Estimation of Questionnaire success 0.2095 0.05 Activity Questionnaire 0.2345 0.05 Self- dependent Questionnaire 0.2669 0.05 Dark blue Lusher’s test 0.2078 Brown Lusher’s test 0.2563 0.05 The persons seeing more of the human images belong to an artistic type. They prefer creative activity, avoid routine and monotony and have orientation on a social recognition. Peculiarity of such persons to preferring the human responses is their strong will, shown in independence of acceptance of the decisions and the creative attitude in life. Such people are independent, are inclined to over estimate the creative abilities and success, but may have low activity and latent somatic problems. In Cassell’s opinion the low responses of human category may indicate the desire to be away from humans and/or social isolation or schizoid tendency. C. Animal responses (A) Factor Tests r p Norm of character MMPI -0.2203 0.05 Emotionality MMPI 0.2119 0.05 Logical thinking Raven 0.2622 0.05 Controlling naturalism FPQ -0.2390 0.05 Meticulousness-roughness FPQ -0.2357 0.05 Persistence-non-persistence FPQ -0.2218 0.05 Responsibility-irresponsibility FPQ -0.3297 0.01 Self-criticism FPQ 0.2843 0.01 Suspiciousness (L) 16PF 0.2416 0.05 Hostility Buss and Durkee -0.2101 0.05 The persons, giving preferences to images of the animals, display unusual character and high level of behaviour. Such people display low meticulousness, persistence in achievement of the purpose put before them, smaller responsibility SIS in Americans & Russians 39

with “- let it be as it is” attitude and tendency to display more self-criticism and suspicion. At the same time, by giving more animal responses, they release their hostility (they envy others to a lesser degree, they are less prone to complain about life and unfairness, they are more inclined to trust people, than to suspect them of mercenary intentions). A naturalistic person tends to be harmonious with nature and would let the things be as they are. The negative aspects of these people are laziness or impulsiveness. The basic problems of the persons, preferring to show the responses with the animal images, are irresponsibility of behaviour, lack of appropriate social norms, poor self-control and psychological immaturity. (Weak, strong, willed, selfchecking, psychiatrically immature.) Cassell found that whenever a large number of animal responses are given, the interpretation should be that the respondent is less comfortable with people and seems to be psychologically immature. D. Anatomical responses (At) Factor Tests r p Introversion MMPI 0.2169 0.05 Scientific potential MMPI -0.2100 0.05 Talkativeness MMPI -0.2161 0.05 Social reliance MMPI -0.2083 - Activity Suppos-8 0.2364 0.05 Indirect aggression Buss and Durkee -0.2241 0.05 Feeling of Fault 0.2156 0.05 Large number of anatomical responses positively correlate with introversion of the person. Introverts are known to be more sensitive about self than the external world, they are capable to generate somatic imagery and the sensations. They are inclined to analyse their behaviour, find faults and take corrective measures. Such person understand themselves well, incorporate anatomical structure and are closed to external supervision. They subjectively highly estimate the activity or aspiration to act (impulsive, restless, intolerant, active, unguided), that indemnification can be considered as hyper compensation; they are less communicative and less sure in their social competence; and their scientific potential is less expressed. Problems of such person are increased due to introversion, shown in insufficient 40 Khromov et al

social involvement, and more interested in self. In Cassell’s opinion more of anatomical responses can be considered from the point of view of psychoanalysis, as fear of death. These responses are consistently high in those who have poor self-image (the image “ego” is poorly generated), and who are preoccupied with internal body organs. E. Sexuality (Sex) Factor Tests r p Extroversion 5FPQ 0.2513 0.05 Attention-getting 5FPQ 0.2183 0.05 Warmth 5FPQ 0.2044 - epressionness- non-depression 5FPQ -0.1928 - Deliberation-let-it-be-ness 5FPQ -0.1983 - Inner sensibility 5FPQ 0.2520 0.05 Anxious 16PF -0.2294 0.05 Emotionality 16PF 0.1928 - Logic thinking Raven -0.2989 0.01 The sexual responses to somatic imagery help in understanding the extroversion aspect of a person. Such people are attracted to the person of an opposite gender, they feel happy when others pay attention to them. They are rich in utilising life experiences and they are able to maintain their emotional equilibrium. Such persons with advanced logic, perceive less of sexual images and tend to see somatic imagery. Cassell says that heightened anxiety and pathology may be associated with either heightened projection or impaired recognition of embedded sexual structures. These may signify sexual anxiety and/or dysfunction. In our research healthy subjects have shown normal reactions to SIS test and their correlations with movement responses are discussed ahead; Negative correlation of the responses of movement with the basic clinical scales of the MMPI – D, Pd, Pa, Pt, Sc are observed. The average and low scores suggest that they are able to control their behaviour in society. Such persons are peace loving, sober, outgoing and practical minded. They prefer rational approach while taking decisions. More responses indicate that they are cooperative, conventional type, trustworthy and aspire to get on with others. More movement responses further indicate – higher serviceability, ability for educational activity (academic potential), developed emotionality and optimism SIS in Americans & Russians 41

with low anxiety and nervousness and good self estimation (all these parameters are received on additional scales of the MMPI). A positive correlation of the responses movements of the SIS with higher scores on MMPI scales are indicative of high motivation leading to success in educational activity. F. Movement (M) Factor Tests r p Lie (L) MMPI -0.2625 0.05 Frequence (F) MMPI 0.2746 0.01 Correction (K) MMPI 0.2632 0.05 Depression (D) MMPI -0.2445 0.05 Psychopathic deviate(Pd) MMPI -0.3288 0.01 Paranoia (Pa) MMPI -0.2457 0.05 Psychasthenia (Pt) MMPI -0.2245 0.05 Schizophrenia (Sc) MMPI -0.2518 0.05 Conventional Type person Holland 0.2035 - Cooperating Type person Leary 0.2573 0.05 Emotional stability 16PF 0.2336 0.05 Suspiciousness (L) 16PF -0.2445 0.05 Shrewd (N) 16PF 0.2200 0.05 Self-controlled (Q3) 16PF 0.2101 0.05 Intensity relaxation (Q4) 16PF -0.2517 0.05 Serviceability MMPI 0.3472 0.01 School potential MMPI 0.2627 0.05 Sensitivity MMPI -0.2567 0.05 Alarm MMPI -0.3075 0.01 Nervousness MMPI -0.2673 0.05 Emotionality MMPI 0.3119 0.01 Optimism MMPI 0.3276 0.01 Dependence MMPI -0.2376 0.05 Self-estimation MMPI 0.2771 0.01 Hostility MMPI -0.2541 0.05 Altruism MMPI 0.3205 0.01 Logical thinking Raven 0.2374 0.05 Mental calmness Suppos-8 0.2840 0.01 Activity Suppos-8 0.2729 0.01 Motivation Questionnaire 0.2551 0.05 Estimation of success Questionnaire 0.2316 0.05 Rigidity Questionnaire -0.2164 0.05 Emotional excitability Questionnaire -0.3365 0.01 The healthy persons do not aspire to present themselves in favourable light, they have not enough tendency to embellish themselves, they are more frank and open in dialogue, they are diligent and responsible in activity, and display attachment to social interaction, they are in good control, without pressure over their emotions. 42 Khromov et al

The study showed that the benign movement responses suggest a healthier personality. Absence of movement responses is indicative of withdrawal and inert personality. G. Most-Typical Responses (MT) Factor Tests r p Obedient, timid type of person Leary 0.1983 - Extraversion-Intraversion 16PF -0.2253 0.05 Self-sufficient-Group-dependence (Q2) 16PF -0.2094 - Dominance-submission 5FPQ -0.2094 - Attention getting-attention avoidance 5FPQ -0.2161 0.05 Persistence-non-persistence 5FPQ -0.2049 - Communicativeness MMPI -0.2130 0.05 Susceptibility Buss and Durkee 0.2426 0.05 Mental anxiety Suppos-8 0.2168 0.05 Fears Suppos-8 0.2324 0.05 In Cassell’s opinion the higher number of the Most Typical Responses is suggestive of coherent, logical thinking and ability to keep up with the demands of society. It may also be interpreted as a measure of ego-strength and team concept. The correlation analysis of our research further suggests that the persons reacting to the images depicting the Most Typical Responses do not belong to the group of highly adapted persons. Such individuals show introversion, dependence on group and do not attract attention of others. They are obedient, timid type of people and inclined to complain on life. H . Atypical Responses (AT) Factor Tests r p Lie (L) MMPI 0.2037 - Communicativeness MMPI 0.2090 - Artisticness 5FPQ 0.3495 0.01 Attention getting 5FPQ 0.2282 0.05 Persistence 5FPQ 0.2191 0.05 Dominance 16PF 0.2978 0.01 Imperous, leading type person Leary 0.2210 0.05 Irritability Buss and Durkee 0.2118 0.05 Logical thinking Raven 0.2384 0.05 SIS in Americans & Russians 43

Atypical responses to the images of the Somatic Inkblot technique are often given by the artistic type persons. They are inclined to attention seeking behaviour, showing aspiration to present themselves in the lime light, denying weak-willed in behaviour. They are dominant, easily irritated with high level development of visual-imaginative thinking. Peculiarity of such people is a combination of the tendencies of the dominating and artistic. They display persistence in achievement of the purpose, that makes them leader and strong type of person. In Cassell’s opinion many Atypical responses are indicative of psychological disturbances. Such responses are usually low. I. Positive Emotion, Optimism (Op) Factor Tests r p Anxiousness 16PF -0.2169 0.05 Sensation Forces and energy Suppos-8 0.2329 0.05 In the healthy and harmonious person, as a rule, there prevails a positive emotional tone, optimistic attitude to life, that is displayed in character of statements on the images of the SIS through contents such as the ascending sun, cheerful person, laughing man, etc. The scale of positive emotions, feelings, optimism correlate positively with subjective estimations of sensation of force, energy and with a low level anxiety. Such persons can be characterized as vigorous, healthy individuals. J. Heart Responses Factor Tests r p Emotionality 5FP 0.2204 0.05 Cooperation 5FP 0.2104 0.05 Self-criticism 5FP 0.2806 0.01 ersistence-non-persistence 5FP -0.2100 0.05 Pernicious habits -0.2099 Material Needs -0.2194 0.05 Perception of the heart responses wherever projected on SIS images are indicative of good body awareness, strong emotional attachment and empathy with an attitude of cooperation with others. Non perception of such images may indicate emotional detachment and self-centeredness. 44 Khromov et al

K. Somatic Repression Scale (SRS) Factor Tests r p Artistic type of person Holland 0.3198 0.01 Social type of person Holland 0.2492 0.05 Cooperating, conventional type person Leary 0.2452 0.05 Gregariousness 5FPQ 0.2101 0.05 Attention getting 5FPQ 0.2474 0.05 Sensitiveness 16PF 0.2936 0.01 Experimenting conservative (Q1) 16PF -0.2449 0.05 Self-sufficiency-group-dependent (Q2) 16PF -0.2213 0.05 Sum of coefficients of color’s deviations Lusher -0.2372 0.05 The persons showing somatic repression are artistic, social, cooperative and conventional type of person. The person of an artistic type, by virtue of the advanced imagination, easily generates ideas, and if necessary, replaces the somatic image to socially acceptable responses. Such people display a higher degree of communication and tolerance, intimate relations with people and are sensitive and inclined to attract the attention. L. Pathological Anatomy Scale (PAS) Factor Tests r p Requence (F) MMPI -0.2726 0.05 Optimism MMPI -0.2284 0.05 Force ero (G) 16PF -0.2354 0.05 Persistence-non-persistence 5FPQ -0.2255 0.05 Logical thinking Raven 0.2188 0.05 In Cassell’s opinion, the subjects who have concern for their personal health, suffer from physical disorders. They identify with the health of others and give more pathologically identified anatomical responses in comparison with the healthy people. In our research, persons, showing pathological responses may be characterized as pessimistic, are less open in dialogue and in the response on the verbal test. They are less conscious and nonpersistent in activity. M. Hostility and Aggression (HAS) Factor Tests r p Mental anxiety Suppos-8 -0.2187 0.05 Feeling of fault Buss, Durkee -0.2346 0.05 Clarity of purpose Questionnaire -0.3325 0.01 Aggression Test 0.2209 0.05 Sex Comic phrases -0.2200 0.05 SIS in Americans & Russians 45

The persons, showing aggression and hostility, are inclined not to display demonstrable behaviour, mental anxiety and the feeling of fault is not advanced; their clarity of purpose (will) is poorly expressed. Such people make ambiguous comic statements and are excited with sexual problems. Their aggressive responses to the visual stimulus correlate with aggressive responses to comic phrases of the verbal projective tests and confirms personal aggressiveness. N. Depression (D) Factor Tests r p Artistic type of person Holland 0.3402 0.01 Social type of person Holland 0.2256 0.05 Norms of character MMPI -0.2120 0.05 Nervousness MMPI -0.2191 0.05 Persistensness non persistensness 5FPQ -0.2218 0.05 Self-criticism 5FPQ -0.2088 - Rigidity Questionnaire -0.2164 0.05 Violet color Lusher -0.2224 0.05 The data of the study suggests that depression is more a characteristic of persons of artistic and social type. In Cassell’s opinion sometimes clinical depression masks in a refusal to distinguish depressive context is projected through plenty of anatomical responses of pathological character. O. Need for Approval, Paranoia Scale (P) Factor Tests r p Artistic type of person Holland 0.2106 0.05 Dependent, obedient type of person Leary 0.2299 0.05 Estimation of success Questionnaire 0.3058 0.01 Rivarly MMPI 0.2162 0.05 Sum of factors deviation of color Lusher -0.2137 0.05 Suspiciousness (L) 16PF -0.2239 0.05 Sensitiveness 5FPQ 0.1990 - The responses, received from healthy subjects on visual stimulus of anatomical character, in which images of staring eyes are mentioned, are characteristic of persons, relating to dependent, obedient type in classification of Leary and artistic type in classification of Holland. The scale has positive correlation with a subjective estimation of success in activity, rivarly and also with smaller suspiciousness and with best physiological state (the data of colour test). Peculiarity of such persons are aspiration to receive approval and recognition of the environment. Such people are trustworthy and dependent. The aspiration to recognisation of such persons is higher, if they have better physiological state. References References including Russian adaptations can be obtained from Dr. Anatoly Khromov, Kurgan State University, Kurgan, Russia. 46 Khromov et al

SIS-Video in a Case of Depression M. K. Tewari and Padma Dwivedi The Somatic Inkblot Series-Video has proved to be an effective instrument in hearing the inner cry of a suffering individual which may not be possible otherwise. A person may narrate his symptoms and the problems at conscious level but unable to understand the reason of these uneasy feelings. Painful experiences and repressed desires form the material of unconscious mind and such material may lead to symptoms. Projective tests particularly inkblot tests help in understanding such unconscious phenomena. Since Inkblot test does not use verbal language, it brings out whatever is buried in the mind closer to consciousness through the media of inkblot images. Many patients dream after viewing the video test which further helps in understanding the psychopathology of the case and processing their repressed unconscious material. A case study with the help of SIS- Video and its interpretation has been given here. Mrs. X, 40 years, married, post graduate, working in a bank, had complaints of panic attacks, (since 1985), lack of sleep (gets sleep for 1 to 4 hours since 1990), feeling of heaviness in left hand and leg (since 1990), occasional attacks of breathlessness and left sided chest pain. She was hypertensive but controlled on antihypertensive agents. She had earlier been admitted in 1985 for similar complaints in PGI, Chandigarh. She belongs to a middle class business family. She was married to an employee of a bank at the age of 28 years. Her first interaction with her husband was unpleasant. After the marriage her husband said that he married her because he wanted a lady to look after my mother. I will not go for children as you will not be able to take care of my mother. As a consequence of it, her husband avoided physical relationship with Mrs. X and later she learned that he had problem of impotence. All this disturbed the patient very much and she started feeling depressed. Her symptoms aggravated after the murder of her niece in 1985 by niece’s husband who was a doctor and was currently serving a jail term. The patient was very attached to the dead niece, as she had been brought up during her childhood by the patient. Later, the patient learned that the husband of the patient had extramarital relationship with another employee of the bank and had proceeded to the court for divorce with the patient. The case is still pending in the court. The patient is living along with another girl who happens to be a close friend since early childhood. She feels very depressed in the evening and gets panic attacks during night. She is afraid of staying alone in the night and gets problems such as increased anxiety, insecurity and heart beating. Two to three times it so happened that she went to hospital during night for help. She was treated by physicians, neurologists and psychiatrists but to no relief. At this juncture, she was referred to the author for help. The Somatic Inkblot Series Video was administered for tapping the underlying unconscious material. SIS-Video was administered to her following its standard procedure. She was M.K. Tewari M.S., M.Ch., Assistant Professor in Neurosurgery and Padma Dwivedi MA (Soc) Social Worker in the Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh-160012. (INDIA)

helped to relax before viewing the video. She was also asked to select three images she liked the least at the end of the test. A few responses found clinically significant are given below along with their interpretation. On image 3A she saw “Blood stains”. She was asked to imagine if something related to this blood stain in her past. She could relate it to the murder of her niece whom she liked the most. Patient was very much attached to this girl and she looked after this girl during her early childhood, the girl was later poisoned by her husband. Patient developed a lot of somatic symptoms after this incident. She in fact feels relieved to some extent as the husband of her niece was now in jail for 10 years. On image 9A she could view “A boy after a girl” which might be indicative of patient’s husband who is creating problems and planning to get divorce from her. Such responses bring out her anxiety, threat and insecurity. Even this response can be interpreted to reveal her suspicious attitude towards her husband. On image 21A she saw “Two children” and avoided to see the main figure. The main figure is viewed as "Turtle or flying man with babies on sides". Avoiding the main figure further indicates her aggression to see the authority/manly figure, which might be representing her husband. On image 25A she has seen “Indian Lamp”. Normally people see “Female sex organ” on this image. Avoiding sexual imagery indicates her frustration in the sex area. Her case history suggests that she was deprived of sex for last 4 years. She is staying separately having no relationship with her husband. On image 27A she could view “Knee” instead of “Breast” which further confirms her conflict in sex area. On intervention she comes out with feelings that “I would have been better off had I got married to some one else. I could not become a wife or a mother”. She further narrated that “I liked children very much and still fond of children but I could not become mother”. Avoiding to see “Breast” may further indicate her conflict as a mother which she could never become. On image 2B she viewed “A murdered body full of blood”. It could take her back in time and theme of the murder of her niece was brought back through this image. As indicated in the case history, the niece was very close to the patient. The patient always considered her as her own daughter. Her eyes were full of tears, though she was able to control her emotions. This image could bring out unprocessed unconscious material and inner cry. The patient felt relieved after discussing about her niece. On image 18B she could view “Penis erected one” which may connote her sexual desire and frustration in phallic area. On image 19B she saw “Heart with a number of injuries and agony”. Her 48 Tewari & Dwivedi

inner cry is brought out on surface once again and she becomes really sad on recollecting her past and the ill treatment of her husband and in-laws. On Image 22B which she saw “Man buried under stone” indicates her depressive contents. She feels there is nothing left for her. Lot of unmanageable situations which have brought her really down. This may also indicate her wishful thinking if she was dead before facing all such problems. This might also be indicative of her hostile attitude and wishful thinking to see her husband dead. On image 28B she saw “A scientist in deep concentration”. This brings out her conflict with mother/mother figure. Normally people see “Mother and child” on this image. Her case history suggests her conflicting relationship with her motherin-law as evident from her case history. On image 31B she saw “A happy family” but did not elaborate further as to who they are. Normally people see “ Husband wife and two children” on this image. This can also be interpreted as the disturbed family situation in the present case as she has been deprived of motherhood and as such has no family of her own. The three images she did not like were 8B, 19B and 22B. Explanation of her responses on 19B and 22B has already been given earlier. On 8B she saw “Moon is so beautiful but this blot vanishes its beauty”. This connotes the depressive feeling of her marriage. She feels that her marriage has become a blot on her face. When she was asked to tell more as to what comes to her mind after viewing this image, she said “I am OK – beautiful so far my looks is concerned. I could have got married to some one else but after this marriage nothing is possible. People have their own reservations about a divorced lady. This marriage has become a blot on my face”. While talking on this image, she was feeling helpless and depressed. She was further helped through hypnotic relaxation and imaging therapy and is showing improvement. She did not get panic attacks during the last 2 months after relaxation therapy. In the follow-up in last 4½ years it has been observed that there had been minimal panic attacks and she had not been to hospital/clinic for these attacks and has been without antihypertensive agents all these years. Conclusion Somatic Inkblot Series-Video is a powerful projective test which helps in hearing the inner cry of the suffering individual. Through image 8B the therapist was able to peep into the inner depth of psyche of this patient and she was helped through therapeutic intervention. SIS in Depression 49

Effect of Age and Sex on the Perception of Total Number of Inkblot Images M. P. Singh, Mridula Mishra and Nalini Mishra This paper reports differences in total number of responses on SIS-II in male and female adolescents adults, late adults and old aged subjects. High and low scorer males (n=240) and females (n=240) were identified by the median cut-off score on the criterion of total number of responses (R). Chisquare tests between male and female adolscents, adults and late adults showed significant differences, while old age subjects failed to show a significant sex difference. Within sex comparisons showed significant differences only in females acrose age groups. These results thus demonstrate the effectiveness of R in differentiating personality characteristics of males and females across different age groups. The Somatic Inkblot Series Test helps therapist more sensitively to hear a suffering individual’s cry for help, the ‘inner cry’ that is hidden not only from others but often from one’s own conscious awareness as well. This is the ‘magic’, the unique, distinguishing, feature of projective testing so elegantly demonstrated by the genius of Hermann Rorschach. The Somatic Inkblot Series is a powerful diagnostic tool which is not only diagnostic but is also therapeutic. This is the latest projective test which accesses information about the individual not readily available in history taking, interview, mental status examination or other forms of testing. In SIS test clinically significant blocked materials override typical normative responses directly (manifest) or in symbolised imagery similar to dream work (latent). Because there is no time limit, “test anxiety” is greatly reduced and the individual is free to react in his or her own time, often exhibiting significant verbal and non-verbal clues to each of the inkblots. The subject is also asked to select three Inkblot Images which (s)he likes the most and three images which (s)he likes the least. The least liked images provide clues to the area of disturbance. The present study aims to find out the effect of age and sex on the length of the protocol. Method Samples A total of 480 subjects, 60 in each of the four groups (adolescents, adults, later adults and old) were taken for study. Half of the subjects in each group were males and half were females. M. P. Singh, M. Phil., Lecturer in Psychology, Desh Bhagat College, Dhuri, Sangrur (Punjab) India. Mridula Mishra, Ph. D., SIS Center, 196, Saket Colony, Naria, Varanasi-221005 (India) and Nalini Mishra, Ph.D. Lecturer, Maharani Banaras Mahila Mahvidyalaya, Ramnagar , Varanasi.

Tool SIS-II test was administered following the standard procedure (Cassell and Dubey, 1997) Procedure To find out the differences among various subgroups the combined medians were found out and x2 tests were calculated between high and low scores on the criterion of median cut-off point. Results and Discussion Table 1 reveals that combined median cut-off points for the total number of responses were ≥ 64 and ≤ 63. Significant differences between male and female adolescents, adults and later adults were observed, as their chi-squares were found to be 12.12, 7.5 and 5.08 respectively. No significant difference between males and females of old age was observed (X2 = 0.30 ns). Adolescent and old age females showed higher number of responses than their male counterparts whereas adults and later adult females showed lower number of responses than their male counterparts. Table 1 Chi-Square of Males and Females of Four Age Groups on Total Number of Responses Median Adolescent Adult Later Adult Old Age Cut-off points Male Female Male Female Male Female Male Female ≥ 64 ≤63 X2 = 12.2** 7.5** 5.06* 0.30 ns. * Significant at 0.05 level. ** Significant at 0.01 level. Ns Not Significant Table 2 depicts the effect of four age groups i.e. male adolescents, male adults, male later adults and old age persons on the projection of total number of responses. No significant differences between extreme scorer males across four age groups were observed, as the chi-square was found to be 1.27 which is not significant. Effect of age and sex on SIS 51

Table 2 Chi-Square of Males of Four Age Groups on Total No. of Responses Median cut-off Adolescent Adult Later Adult Old Age points ≥64 X2 =1.27ns ≤63 Table 3 shows that the females of all the four age groups i.e. adolescents, adults, later adults and old age, were significantly different on the projection of number of responses ( X2 = 24.60 P<0.01). Adolescent and old age females showed higher responses whereas adults and later adults showed lower total responses. Table 3 Chi-Square of Females of Four Age Groups on Total No. of Responses Median cut-off Adolescent Adult Later Adult Old Age points ≥ 64 X2 =24.60** ≤ 63 ** Significant at 0.01 level. The effect of age and sex was observed for the criterion of number of responses. All the male adolescents, adults and old age persons were compared with their female counterparts and it was found that sex has influencing effect on the total number of responses, except in the case of old age. However, age has been found to be an influencing factor on the number of the responses amongst female subjects. No effect of age was observed on male counterparts. Adolescents gave more responses as compared to adults and late adults. Thus, the effect of age and sex was observed on the total number of responses. The total number of responses suggest imaginative capacity and functioning intelligence of the subjects. Normal subjects have been found to give 61 to 65 responses on SIS-II whereas psychiatric patients give low responses, ranging from 51 to 65 as reported in earlier studies (Dubey, Cassell, Pershad and Dwivedi 1995). The findings suggest that age and sex has a bearing on the number of responses on SIS-II images. References Cassell, W.A. (1977), Desensitization Therapy for Body Image Anxiety. Canadian Psychiatric Association Journal, 22 ; 239-242. Cassell, W.A. (1980), Body Symbolism and SIS, Aurora Publishing Co. Anchorage, Alaska. Cassell, W.A. and Dubey B.L. (1997), SIS-II/Video Manual, SIS Center, Anchorage, AK, USA. Dubey, B.L., Cassell, W.A., Pershad D. and Dwivedi, P. (1995), Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. Psy. & Ment. Health, 2 : 77-84.

Evaluation of Piotrowski’s Organic Signs of Head Injury S. Chaudhury, T. R. John, H. S. Bhatoe and S. Rohatgi The Rorschach test by Klopfer’s method was administered to 75 consecutive injury patients and equal number of age, sex, education, marital status, economic status, domicile and intelligence quotient matched normal control subjects. Utilising the Piotrowski signs we identified 49 of the head injury patients and six of the control subject positive for organic diseases of the cerebral cortex. The difference was highly statistically significant. The Piotrowski signs in the head injury patients had a sensitivity of 65.3% specificity of 92.7% and overall diagnostic power of 78.7% clearly indicating that it is a useful test in the clinical setting. Over the years the number of Rorschach sign systems for identifying brain impairment have appeared in the literature. The first and the most widely used of these systems consist of the ten signs suggested by Piotrowski (1937, 1940). The Piotrowski signs identified the diagnostic category of no fewer than 51% and as many as 97% of the patients (organic and mixed psychiatric) and control subjects in 11 reported studies (Lezak, 1995). A common drawback of many of the studies was the inclusion of mixed organic patients. A number of studies also employed 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 homogeneous as to diagnosis, age and intelligence (Goldfried et al 1971). In view of the shortcomings of the early studies and paucity of Indian studies the present work was undertaken to evaluate the Piotrowski signs in head injury patients. Material and Method The study was carried out at the Neurosciences Center, Command Hospital, Northern Command April 97’ to March 98’. All male inpatients with head injury referred for neurosurgical management formed the patient sample. All the patients were on appropriate drugs, and had not suffered from an epileptic fit on the day or the day prior to the administration of the Rorschach test. Intelligence quotient was assessed by the Revised Bhatia’s. Short Battery of Performance Tests 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 psychiatric illness Suprakash Chaudhury, M.D., Ph D., Head, Psychiatry Department, T. Rajan John, M.D., Psychiatrist, Harjinder Singh Bhatoe, M.S. (Medicine), D.M. (Neurology), Neurophysician. Command Hospital, Northern Command, C/O 56 APO.

formed the control group. Control subjects were also examined by neurophysician to rule out organicity and underwent the Rorschach test. The Rorschach test was administered individually to the subjects and scored by Klopfers method. The ten Piotrowski's signs of brain damage are as under : 1. R. Total responses are less then 15. 2. T. Average time per response is more then 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 responses is given on 3 or more cards. 8. Impotence, Imp. Scored when the response is given in spite 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 etiology 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 or absence of each sign. Statistical comparisons were performed using the Chi-square test. Results There was no significant difference between the head injury patients and control subjects with regard to age, education level, marital status, economic status, domicile and IQ. All subjects of the study were male. By the criteria of five or more Piotrowski signs, 49 of the epilepsy patients and 6 of the control subjects 54 Chaudhary et al

were diagnosed as organic. The difference was statistically significant (X2 = 53.08 ; df = 1 ; P < 0.01). The percentage of the occurrence of the individual Piotrowski's signs in the present study and two earlier studies is shown in Table 1 for head injury patients and Table 2 for control subjects. Comparisons of incidence of Piotrowski's signs in head injury patients and control subjects is given in Table 3, while the efficiency of Piotrowski signs in the diagnosis of organicity in head injury patients is given in Table 4. Discussion Studies of Rorschach performances of head injury patients show some consistent response characteristics. Prominent among these are a reduction in number of responses, a relatively greater number of poor form responses, loose associations, stereotype (repetition, preseveration) and concreteness (Darley, 1956, Ellis & Zahn, 1985, Vigouroux et al 1971). Our findings are broadly in agreement with these (Table 1). Table 1 Occurrence of Piotrowski's Signs in Head Injury Patients in Percentage Study Sample R T M Cn F% P% Rpt Imp Plx AP size Aita, et al (1947) - - - 11.7 - - 21.7 41.6 45.0 26.7 Hertz & Loehrke (1954) 50 34.0 26.0 58.0 20.0 34.0 46.0 20.0 26.0 26.0 16.0 Present Study 76.0 40.0 78.7 5.7 78.7 57.3 66.7 32.0 22.7 5.3 The identification of a high number of head injury patients and a significantly lesser number of normal subjects as positive for Piotrowski's signs is in agreement with earlier studies (Hertz & Loehrke, 1955 ; Lezak, 1995) and indicates the robustness of the signs. The limiting factors of the course is the presence of too many false negatives for which the Piotrowski signs have often been criticized (Goldfried 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. Table 2 Occurrence of Piotrowski's Signs in Non-Brain Damaged Subjects in Percentage Study Sample R T M Cn F% P% Rpt Imp Plx AP size Aita, et al (1947) - - - 3.0 - - 11.0 9.0 15.0 12.0 Hertz & Loehrke (1954) 50 14.0 10.0 52.0 10.0 12.0 20.0 2.0 2.0 2.0 2.0 Present Study 50.7 18.7 52.0 0.0 21.3 25.3 8.0 4.0 2.7 0.0 Piotrowski's organic signs 55

Table 3 Comparison of Incidence of Piotrowski's Signs in Head Injury Patients and Normal Controls Study Sample size R T M Cn F% P% Rpt Imp Plx AP Head Normal Injury Controls Patients Aita, et al (1947) 60 - - - NS - - NS S S S Hertz & Loehrke 50 S S NS NS S S S S S S (1954) Reitan (1955) S NS NS NS NS NS NS S NS NS Present Study S S S NS S S S S S NS Perusal of Table 1-3 reveals that there are no signs which consistently appear in such an overwhelming proportion of the head injury patients or which appear so infrequently in the normal subjects while occurring with greater frequency in the head injury patients as to be considered to be clearly pathogonomic of organicity. On the other hand it is evident from Table 4 that Piotrowski's signs in the present study and the earlier studies have a high specificity but moderate sensitivity for the diagnosis of organicity in head injury patients. Further, the sum of sensitivity and specificity of the Piotrowski's sign in the two studies is consistently greater than 150 which proves that it is a useful test in the clinical setting. Further studies of Piotrowski's signs in head injuries of varying sites and its relationship to injury severity would be of interest. Table 4. Efficacy of Piotrowski’s Signs in the Diagnosis of Organicity in Head Injury Patients. Variable Hertz & Loehrke Present study (1954) SAMPLE SIZE Head Injury Patients Normal Controls Sensitivity 65.3 Specificity False Positive rate False Negative rate 34.7 PREDICTIVE POWER OF Positive test Negative test 70.4 72.6 Overall Diagnostic Power 78.7 56 Chaudhary et al

References Aita, J. A., Reitan, R. M. and Ruth, J. M. (1947) Rorschach test as a diagnostic aid in brain injury. American Journal of Psychiatry 103 : 770 – 779. Darley, G. A. (1956) Psychological findings five years after head injury. Journal of Clinical Psychology 12 : 440 – 443. Ellis, D. W. and Zahn, B. S. (1985) Psychological functioning after severe closed head injury. Journal of Personality Assessment 49 : 125 – 128. Goldfried, M. R., Striker G. and Weiner, I.B. (1971) Rorschach Handbook of Clinical and Research Applications. New Jercy : Prentice- Hall Inc pp 291-295. Hertz, M. R. and Loehrke, L. M. (1954) The application of the Piotrowski and Hughes signs of organic defect to a group of patients suffering from post- traumatic encephalopathy. Journal of Projective Techniques, 18 : 183 – 196. Lezak, M. D. (1995) Neuropsychological Assessment 3rd ed. New York : Oxford University press. 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. Reitan, R. M. (1955) Evaluation of the Post-concussion Syndrome with the Rorschach Test. Journal of Nervous and Mental Disease, 121 : 463-467. Verma, S. K.., Pershad, D., Malhotra, A. and Arunima (1988) The Revised Bhatia’s Short Battery of Performance Tests of Intelligence. National Psychological Corporation, Agra. Vigoroux, R. P., Baurand, C., Naquet, R. et al (1971) A Series of Patients with Cranio-Cerebral Injuries Studied Neurologically, Psychometrically, Electro-encephalographically and Socially. International Symposium on Head Injuries Edinburg : Churchill- Livingstone. Piotrowski's organic signs 57

Maintaining Mental Health of the Aged Through Psychosynthesis N. L. Dosajh This paper deals with the increasing number of the Aged and their problems especially the very serious ones like Senile dementia and Alzhmeir’s disease Hirtington’s disease etc. and suggests Psychosynthesis as a means of prevention and treatment. The paper also gives very briefly the various steps of psychosynthesis. The results are based on a trial of this method on 22 cases in the range of 35+ to 80+ years of age. The number of the aged persons is increasing at an alarming rate and so are the problems associated with aging. Some of the problems are very severe for which no definite cure has been discovered so far, for example senile dementia, parkinson’s disease, alzhmeir’s disease, Hirtington’s disease, diabetes etc. A good deal of research is going on especially on Alzhmeir’s disease and diabetes but no definite cause or causes are attributed to such diseases, except in the case of alzhmeir’s disease, neurologists say that these diseases are due to some changes in the hypothalamus. There are a number hypotheses and theories about the changes in hypothalamus but they all end up by saying that the scientists are not sure whether aging is due to changes in the hypothalamus or vice-versa. Drug therapy has tried certain drugs but without success. Tacrine HCI has improved the functional ability in some cases. Many, however, are unable to derive benefit from the drug because of its harmful effect on liver and gastrointestinal complaints (1996). The author has tried psychosynthesis with an incidental sample of 22 persons, above the age of 35 years (The break-up of the sample is shown in appendix I). Out of this sample, 20 patients have benefited a lot. So, according to the author, psychosynthesis may be one of the solutions for such ailments. The author does not mean that psychosynthesis will prevent aging but he does mean that it will go a long way in solving most of the problems of the aged. So let us now try to understand very briefly this very vast topic of psychosynthesis. Psychosynthesis Psychosynthesis of R.A. Assagioli (1959) and Integral Yoga of Sri Aurobindo (1953) are nearly the same. What Aurobindo calls ‘Psychic Being’, Assagioli designates as ‘True Self’. Each gives a method of integrating the various subpersonalities of the individual. The initial stage is body-mind integration. Both body and mind interact upon each other, the body acts on the mind and mind acts on the body, as the saying goes- A sound mind in a sound body. This synthesis is followed by body-mind-spirit integration. This trio leads to complete synthesis and is designated as psychosynthesis or integration. Achieving this complete synthesis, is a life-time process. For the integration of body-mind, we have to Prof. N. L. Dosajh, Ph.D., 1121, Sector 15-B, Chandigarh-160015 (India)

deal with sub-personalities like physical, emotional, social and mental. Any defect in the development of these sub-personalities results in an obstacle to complete synthesis or integration. So, if there are some defects they have got to be removed first by psychoanalysis, psychotherapy, cognitive therapy, relationship therapy or Yoga or any combination of these and others. For the development of physical and mental aspects of sub-personalities a number of physical and mental exercises have been prescribed. They include Yogic exercises as well. The author has prescribed sixteen yogic exercises (1983). These exercises have been carefully selected after consulting and trial by a number of yoga practitioners, out of a multitude of yogic exercises, beyond the number of eighty (1972). The effort was to select as few exercises as possible and only those that are absolutely essential for maintaining good physical and mental health. The present day man is extremely busy and so time factor has been kept in view-the motto being-to obtain the maximum benefit in a minimum time. Next comes the sub-conscious of the mental make-up of the personality, from where the various conflicts, complexes, prejudices and repression etc have to be removed because it is they that cause various psychological troubles. This is achieved through various techniques like projective techniques, dream analysis, word-association and self-analysis through meditation etc. After this the individual is ready for the psychsynthesis which enables an individual to raise his consciousness level. (For levels of consciousness, see appendix II, Dosajh, 1998 July). The raising of the consciousness leads to the solution of various problems (1991), and lowering of consciousness leads to all sorts of psychological abnormalities (see appendix II). The raising of consciousness is achieved through meditation of many kinds. One can chose any one type of Meditation according to his personality make-up (Dosajh 1990) and stick to it till the objective is achieved. Psychsynthesis sessions can be conducted by trained Clinical Psychologists in groups of 10 to 20 aged persons at a time. Each session lasting for about 40 minutes each and these are continued till the satisfaction of each participant. Appendix 1 Incidental Sample - of 22 persons . Age range - 35+ years to 80+ years. Educational Qualification – Mostly Graduates and Post- graduates. Break-up Age Male Female Total In thirties In forties In Fifties In Sixties X X X In Seventies X In Eighties X Grand Total 22 Psychosynthesis & Ment Health 59

Appendix 2 Stages of Consciousness Mystical Macroconsciousness :- Higher intuitions, perceptions and Visions Gravitational Consciousness Psychosynthesis Focused Consciousness Sublimated Consciousness Micro Consciousness Normal Senility Slight forgetfulness Forgetting names of places – Parkinson’s disease & close associates – Alzhmeir’s disease Forgetting to do routine activities – Shopping & balancing Dementia Accounts Needing help in daily routine activities – concentration low, forgetting personal addresses Needs daily supervision in choosing appropriate clothes, meals items etc. Needs help in dressing and going to bathroom – can’t count backwards to ten – can’t recognise people with whom he lives. Incontinence – Ability to speak is reduced. References Assagioli, Robert (1959) ; Psychosynthesis, Psychosynthesis Research Foundation, P.O. Box3895, Greenville, Delware, USA. Aurobindo, Sri (1953) ; The Integral Yoga of Sri Aurobindo by Rishab Chand, Sri Aurobindo Ashram, Pondicherry, India. Aurobindo, Sri (1972) ; The Synthesis of Yoga Therapy, Part II, Pondicherry, vol 20, p. 511. Dosajh, N.L. (1983) ; Psychotherapy including Yoga Therapy, Kohli Publishers, 34, Industrial Area, Phase II, Chandigarh – 160002, 147-158. Dosajh, N.L. (1990) ; Vertical Dimensions of Personality Development, Presidential Address, Indian Psychological Association, Annual National Conference held at Department of Psychology, Bharthiar University, Coimbatore.- 641046, p. 3-5. Gupta, Bhim Sen (1991) ; Divya Chaksu Yoga, Ajit Publishers, Chandigarh. Jolly, J.G. (1996) ; Alzhmeir’s Disease, Chandigarh Newsline, dated March 12, 1996. p. 2. Tart, Charles T. (1975) ; Transpersonal Psychologies, Routledge & Kegan Paul, London, Contents. 60 Dosajh

How Repression of Spiritual Urge Leads to Psychological Troubles N. L. Dosajh This paper shows the importance of ‘Spiritual urge’(S) in human beings, which, if repressed leads to psychoneurosis, just as the repression of sexual urge does. A case-history has been reported to illustrate the phenomenon. The paper also brings out the superiority of SIS (II) in diagnosis of the problem and as an adjunct to Meditation for therapy. A human being is a triune of Body- Mind- Spirit. Some persons perceive him only in terms of body and mind and thus get only a lopsided view of reality. They are generally designated as Materialists and the former as Spiritualists. In this article an attempt is made to show that the repression of the spiritual urge (S factor) sometimes leads to psychoneurosis just as repression of sexual urge does, and suggests a way to deal with this type of psychological troubles therapeutically. On the path of spiritualism, the state of Consciousness gradually rises. According to Anthony Campbell (1980) there are seven states of consciousness :- 1-3. Dreamless, Dreaming and Waking States of Consciousness, when there is no awareness of Self (Self here means the real Self and not the small self pertaining to body only). 4. Transcendental Consciousness :- Here awareness of ‘Self’ is present. 5. Cosmic Consciousness :– Awareness of Self is present and it leads to perception. 6. God Consciousness :- Awareness of Self is present and awareness of outer world is also present. 7. Unity Consciousness :- In this state not only the awareness of Self and the world is present but also conflicts are resolved. Anthony Compbell has taken this idea from Maharishi Mahesh Yogi’s book – The Science of Being and Art of Living (1966). These states of Consciousness can be achieved by various methods. In Indian psychology the method employed is Yoga and Meditation. As far as Yoga is concerned there are many books available. Some of the most important being –‘Light On Yoga’ by B. K. S. Iyengar ; ‘Yoga – A gem For Women’ by Geeta S. Iyengar ; ‘Solar Yoga’ by Yogacharya Jankiraman and Carolina Rosso Cicogna ; ‘Asana, Pranayam, Mudra, Bandha’ by Swami Satyanand Saraswati ; ‘Yoga Prof. N. L. Dosajh, Ph.D., 1121, Sector 15-B, Chandigarh-160015 (India)

Therapy’ by Dr. R. K. Garde ;‘Psychotherapy in India’ by Dr. H. G. Singh; 'Yoga Technique of Psychotherapy’ by Dr. H. L. Sharma; ‘Western Psychotherapies and Hindu Sadhna' by Hans Jacobs ; ‘Pranayam’ by Swami Kuvalyananda. Regarding Meditation, there are many techniques devised by various Yogies. Some of the important techniques are :- 1. TM technique by Maharishi Mahesh Yogi. 2. Vipeshyana Technique by Shri S. N. Goenka. 3. Braham Kumari’s and Braham Kumar’s technique. 4. Satya Sai Baba’s technique. 5. Beas Dera’s technique. 6. Zen Techniques of Budhists. 7. Dialectical Technique by Haridas Chaudhary. The present author has been using a very simple technique for his patients. The various steps of this technique are :- 1. We start with a few Hath Yogic exercises and Pranayam to relax the body and mind. The Yogic exercises chosen are according to the age, state of development and sex of the patient. His physical and mental health are always taken into consideration before prescribing these exercises. 2. The patient is helped to concentrate from concrete objects to abstract ideas. 3. Meditation on real ‘Self.' 4. Meditation on Self merging into Cosmic Self. 5. Meditation on being merged into Cosmos. etc., (Dosajh, 1989). There are many misconceptions about Meditation created knowingly or unknowingly by the teachers of Meditation. The most important misconception is that Meditation is possible only by reciting a particular mantra contained in a particular religious book. This is totally wrong. The main idea in Meditation is concentrating on an object bestowed with certain good qualities, or an idea or ideas which are good for the individual or a person whom the individual admires and whose qualities he wishes to acquire. By meditating on these qualities, he himself begins to imbibe those good qualities and thus raises the level of his consciousness, which in other words leads to vertical development of his personality. (Dosajh, 1989). 62 Dosajh

The result of this Meditation is that the person gradually becomes free from various conflicts and complexes. His mind becomes peaceful and he attains a higher stage of consciousness, which shows him the real path to tread and to achieve something higher, which he wishes to achieve. The author has used this technique of Meditation for the treatment of especially those patients who are held up in the course of development because of the repression of their Spiritual Urge, so called, ‘S’ factor. In the case of good, honest and truthful persons who have led such a life for many years, their consciousness touches reality soon, and when it happens, problems of life pale into insignificance, intuitive ability dawns upon them and they become very useful members to society, good for themselves and good for the humanity. After this introduction, let us now pass on to the discussion of a case of repression of spiritual urge, called by Carl Jung as “Holy Neurosis." Case I A young engineer, B.E. , age about 36 years, holding a very responsible post in a reputed firm, happily married with two children, got promotion because of his good work. Instead of feeling happy, he felt very nervous, proceeds on leave on the pretext of slip- disc and called on the author for treatment. His functional intelligence level, as determined by SPM was nearly 125. After taking his case history, the author administered him ‘D’ test. The responses were quite normal. He was then administered some pictures of the western TAT. The stories only revealed a great attachment to mother and a little resentment towards father (May be Oedipus Complex). During the case history taking he told that he had started smoking very heavily, at least ten cigarettes a day and that his sleep was very much disturbed. And that he could hardly sleep. He was, then, administered SIS-II (Cassell 1990). His responses to the following images were quite bizarre :- 4A : Rat like animal with its tail stuck- up with something. 23A : Spinal chord with an unusual bottom portion with different vertebrae shown. 25A : No response. 10B : Figure of Lord Ganesha with protective covering around it and a sapling at the bottom. 21B : A pistol with flame coming out of the barrel. 25B : An X- ray film spoiled by the bright light. When he was interviewed on the above images, his problem became quite clear. Therapy thru SIS 63

4A : “Yes, this rat is myself. I am stuck like him and do not know what to do. I am timid like a rat. I have lost confidence in myself. I am feeling very diffident of my new assignments.” 23A : “Lower portion of the spinal cord is abnormal. This is what I have told my office that I have slip- disc, just to manage medical leave. Actually there is nothing wrong physically. It is all mental.” 25A : He was pressed to say something. He said with great difficulty that he knew these were female sex organs and this was nothing to do with my trouble. I am quite satisfied with my sex life. So this picture does not bother me at all. 10B : “Yes, This is Lord Ganesha. He has always been protecting me and he will also save me now. I like this picture. I used to pray and meditate before Lord Shiva in my earlier days, which I stopped later on.” He liked talking about this image a great deal. 21B : “This pistol seems to me so because I am under great tension.” 25B : “Again it depicts my mind. There is a bright future but it is all spoiled like these X-ray pictures because I can’t avail of it.” After the interview, he felt great relief and when it was suggested that he may think of Meditation again, he jumped at the idea. He left and after about a week rang me up and told me that he had restarted meditation, keeping Lord Shiva’s picture in front of him and was feeling all right and that he had joined his new assignment with confidence. In this particular case his response to image 10B was very indicative of repressed ‘spiritual urge’, which lay blocked in the subconscious till it was revealed by Image 10B of the SIS-II. References Anthony Campbell (1980) Seven States of Consciousness, p. 110, Victor Gollancez Ltd., London. Cassell W.A. (1990) Administration, Scoring and Interpretation of Somatic Inkblot Series, 4045 Lake Otis, Suite 101, Anchorage, Alaska 99508. Dosajh N. L. (1989) Presidential Address on ‘Vertical Dimension of Personality Development’, delivered at the 1989th Annual National Conference of the Indian Psychological Association, Held at Deptt. Of Psychology, Bharathiar University, Coimbator- 641046 ; p. 3. (copies available from the author, 1121/15 B, Chandigarh – 160015.) Mahesh Yogi (1966), ‘The science of being and art of living’ International SRM Publication, London, Frankfurt, Oslo, Geneva, Toronto, Los Angeles, Rishikesh (India). Tart. Charles T, (1975) Transpersonal Psychologies, Ronteledge & Kegan Paul, London, p. 5. 289 & 434. 64 Dosajh

A Proposed Model for Quantification of Abnormal Somatic Concern on SIS-II S. K. Verma and Harprit Kaur SIS-II, based on the theory of somatic imagery seeks to probe into the abnormal somatic concern of the individual. There is a felt need to develop an index of this abnormal somatic concern based on the qualitative and quantitative analysis of the responses. A model for such an index has been suggested in the fond hope that it would stimulate others to improve upon it and thus a reliable and valid index could be developed. The present work should be viewed as an initial, relevant step only. Somatic Inkblot Series-II (SIS-II) was developed as a paper and pencil test capable of being self administered with supervised instructions with series A and B (62 images in all) by Cassell (1980). As the name itself suggests it is an inkblot test which is to measure somatic concern that is abnormal. It can be and has been used in a qualitative way as a standardized interview with a little ambiguous stimulus-and has been found quite useful too. Lately however there is a growing feeling that this method is highly subjective and descriptive. There is a felt need for quantifying it and quantifying it with added quality to this quantification. The present work is more in the area of doing some loud thinking to make an initial step forward in this direction. Needless to say, it has to be followed up with more intensive work, which will be done and reported in due course of time. Somatic Concern It is normal to expect some degree of somatic concern by normal individuals under certain situations. It is but natural to think about our body-after hard physical and/or mental work, after some illness/disease, accident, operation, examination, or, any other stressful event. Not to be concerned at all under such circumstances, requires persons like saint, mahatma-or, a person with very low intelligence or, a person who is either unconcerned in a shock or, is trying to deny all such wordly worries. Denial may be completely successful or, only partial.

On the other hand abnormal somatic concern is the primary concern of the mental health professionals like us all. It may be of degree or of kind or, both even. The method used so far has been to measure it subjectively or, to measure its different manifestations like mean of anatomical responses, or pathologic anatomy scores, etc. There was no way to measure it in a wholistic manner, combining different scores to give a single index. Mapping Areas of its Manifestations Reviewing of relevant literature on SIS Series (Cassell 1980a, 1980b; Cassell et. al 1994, 1996; Pershad and Verma 1995; etc) have shown that it is possible to measure reliably the somatic concern of the individuals with the help of SIS instruments. The following areas seem to indicate abnormal somatic concern:- a) Anatomical responses:- Their frequency and pathological description of anatomical responses. b) Denial of anatomical responses on images usually showing anatomy but occurrence of such responses on images where it is rare to get them. c) Rejection of images (no response) where anatomical responses are most typical responses. d) Verbal and non-verbal signs of disturbances on images depicting Most- Typical anatomical responses. e) Total number of sex responses. f) Delaying (near rejections) of responses on certain images etc. It is relatively easier to score for all such areas separately but combining them into an index is better, if it can be reliably done and demonstrated to be so. All such indexes have to be arbitrary to some extent, since all definitions are arbitrary. Tool SIS-II is an extension of SIS-I (Cassell 1980a, 1980b, Cassell et.al. 1997; etc.). It is a paper and pencil test and can be administered in a group setting, individually or even self administered after supervised instructions. It consists of an A series and B series each with 31 images (total of 62 images). In addition, there is a sample image in the beginning. SIS-II is known to consist of images specific to elicit anatomical concern of the subjects. A closer look at these images and normative data suggests that there are some images which are associated with more typical (more likely to elicit) anatomical responses-and some of them are even most typical responses (see table 1 for 21 typical responses on series A and 18 on series B, inclusive of the most typical ones - i.e. by more than 75%). 66 Verma & Kaur

Table-1 List of Typical Responses with Anatomy or Sex (on SIS-II) Series A Series B 7A Woman dancing, Eve & Apple, 6B Upper thighs & Lower Seductive Woman Abdomen 8A Man showing male parts 7B Ribs, upper chest 9A Man & Woman dancing, hearts 8B Nose 10A Eyes, Eyes out of focus, woman's *9B Lungs, kidney, penis, face in rear view mirror testicles 11A Nose 11B Lungs 12A Ear 13B Colons, intestines 14A Oesophagus, stomach 16B Spine, Vertebra 15A Stomach 17B Heart 16A Two love birds, hearts 18B Spinal chord, penis in vagina 17A Chest, ribs, heart, lungs 19B Cell, Ovum, Egg. 18A Heart, Female genitalia, Uterus 20B Brain 19A Intestine, Colon 23B Spider, Rib cage, heart, lung *20A Kidney, lungs, thorax 24B Kidneys 22A Spinal Column, Chest, Rib, 25B Pelvis of woman Pelvis, Phallus 23A Spinal Column 26B Female sex organ, vagina, uterus, ovary. 24A Female pelvis 27B Fetus, Embryo 25A Vagina 30B Two ears 26A Fetus, Embryo 27A Human female breast 28A Leg, thigh 30A Skull Total of A+B 39 *Most typical anatomy responses on SIS-II A Suggested Model for Scoring Based on our and others experiences, the following tentative scoring criterion is suggested-subject to further modifications and improvements, in the fond hope that it would generate enough interest in the readers to experiment with this or, a modified version of it depending upon their experiences and inclinations. We have suggested 8 scoring categories, each ranging from 0 to 6 to give equal weightage to each one. In some cases (categories 3 to 8) the maximum score therefore is limited to 6 as in others. Thus the overall abnormal somatic concern score would vary from 0 to 48 which is sufficiently large to include all categories Somatic Concern on SIS-II 67

of subjects and sensitive enough to be able to measure changes after therapeutic interventions or, to spontaneous recovery. Adding Quality to the Quantification In order to add quality to this quantification, further work is needed, particularly to find out its stability over time with and without interventions, as well as with different types of therapeutic interventions. Some work is going on in this direction and shall be reported in due course of time. We would welcome suggestions/ comments from other researchers, as well as their experience with this model. Table-2 Suggested Scoring Criteria for Abnormal Somatic Concern on SIS-II S.No. Scoring Criteria Minimum Maximum 1. Most typical responses on 6 images (12A, 20A, 27A, 30A, 9B and 30B) not given but other responses given. 2. Rejection of 6 images mentioned above 3. Pathologic anatomy score (PAS) 6 (6 even if ≥ 6) 4. Anatomical responses other than those 6 (6 even if ≥ 6) listed in Table 1 (of typical responses). 5. Total PAS Score 6 (6 even if ≥ 6) 6. Total number of sex responses 6 (6 even if ≤ 6) 7. Complaining about somatic symptoms 6 (6 even if ≤ 6) (also self references) on any image 8. Abnormal delays in responding to any image 6 (6 even if ≤ 6) Total Range References Cassell, W.A. (1980 a) Body symbolism and the somatic inkblot series. Aurora Pub. Co. Anchorage, Alaska, U.S.A. Cassell, W.A. (1980 b) Somatic Inkblot Series II. Aurora Pub. Co. Anchorage, Alaska U.S.A. Cassell, W.A. and Dubey, B.L. (1997) SIS-II/Video manual. SIS Center, Anchorage, AK (USA). Dubey, B. L. and Cassell, W.A. (1993) Some experiences with somatic inkblot series. British Journal of Projective Psychology, 38:19-41. Pershad, D. and Verma, S. K. (1995) Diagnostic significance of content analysis of SIS-II SIS Journal of Projective Psychology and Mental Health, 2:139-144. Verma, S.K. (1995) Reliability and validity of somatic inkblot series tests. SIS Journal of Projective Psychology and Mental Health, 2:67-71. Verma, S.K., Pershad, D., Bhagat, K. and Kaur, R. (1996) Interdependence of SIS variablesSomatic Concern on SIS 61 with personality traits in psychiatric cases. SIS Journal of Projective Psychology and Mental Health, 3:51-58. Verma, S.K. Pershad, D. and Nehra, R. (1994) Cross-validation of SIS-II in Psychiatric population. SIS Journal of Projective Psychology and Mental Health, 1:15-18 68 Verma & Kaur

Comparative Efficacy of Pharmacotherapy and Bio- Feed Back among Cases of Generalised Anxiety Disorder P. Sarkar, S. P.Rathee and N. Neera The present study purports to compare the therapeutic efficacy of Bio-Feed Back Therapy (BFB) with Pharmacotherapy among cases of GAD. It includes 50 cases of GAD (M ; 38 & F : 12) in the age range of 20 to 55 years (Mean age 32 years), with their educational qualification, ranging from middle to graduation level and belonging to the three religions (Hindu, Muslim, Sikh). They were randomly distributed for two modes of treatment i.e., Phamacotherapy and BFB therapy (25 cases in each group). Their therapeutic effects were measured through their objective scores on Hamilton Anxiety Rating Scale (Hamilton, 1959) and projective responses on Somatic Inkblot Series-I (Cassell, 1980) in pre and post treatment conditions. The present study reveals the equal importance of both therapies in reducing the GAD symptoms, but the same can be better understood on projective instruments as compared to objective means of assessment. The Generalized Anxiety Disorder (GAD) is one of the most common mental illnesses among psychiatric patients. The treatment of GAD has been the subject of considerable interest and controversy (Jarret & Rush, 1988). Though, medication has been claimed to be the treatment of choice for alleviating anxiety and panic symptoms (Rickels, 1987), problems like resistance to medication, intolerance of side effects and tendency to relapse on withdrawal, have been also reported (Telch, et, al, 1983). Compared with the substantial progress in behaviour therapy in the treatment of phobic disorders, progress in the development of effective treatment of nonphobic anxiety disorder, specially GAD, remained disappointing (Butler, et, al, 1991). In the study of state anxiety scores, Jerath, et, al (1993) have found that high intelligence with introversion traits and task oriented male group tend to manifest significantly lower state anxiety then their counterparts. It was also observed that stress led to more state anxiety and state anxiety was an important determinant of performance apart from intelligence, extraversion and stress. In earlier studies, it has been observed that anxiety management training (Suinn & Richardson, 1971) and Relaxation (Hutchings et, al, 1988) were effective in reducing anxiety, only in a non-clinical population (Barrios & Shigetomic, 1979) P. Sarkar, Psychiatrist, S. P. Rathee, Clinical Psychologist and N. Neera, Psychiatric Nursing Officer, Dapartment of Psychiatry, Command Hospital (WC) Chandimandir (Haryana).

and relaxation therapies had a limited place in the treatment of chronic anxiety (Raskin et, al, 1980). Woodward and Jones (1980) found few therapeutic gains from either systematic desensitisation or cognitive re-structuring and suggested the necessity of some form of multi-dimensional therapies. But, Broota, et, al, (1995) have studied the importance of relaxation therapy in comparison to Jacobson’s relaxation technique and ‘Shava Asan’, in reducing the symptoms of hypertension. They observed that all of these three therapies produced different forms of relaxation effects on Hypertension, but “Shava Asan” to be most effective therapy, followed by Progressive Relaxation techniques. Latest studies have shown the significance of projective techniques, specially the inkblot methods, in not only for their psychodiagnostic utility, but also for hearing the inner cry of suffering individuals. The Somatic Inkblot Series developed by Cassell (1960), is latest of them, which has been observed to be very effective in sharing and treating the inner most problems of the patients. The series have higher therapeutic effects, which has been judged by various authorities in different fields. Among psychiatric and non-psychiatric population (Cassell, 1990; Dubey, et, al, 1995; Amool et al, 1996; Dosajh, 1996, 1997 and Mitra & Mukhopadhaya, 1996; Parshad et, al, 1995; Rathee et, al, 1994, 1997 Gayatri & Kaliappan, 1997). Considering the controversial picture of various therapies among different groups of anxiety. The present study was initiated to measure the effects of Pharmacotherapy and Bio Feed Back therapy, in reducing the symptoms of GAD patients through projective and objective methods. Hypothesis : Both Pharmacotherapy and Bio-Feed Back are good methods of treatment. Material and Method Sample : The present study consist of 50 fresh and symptomatic cases of GAD, who were in the age range of 20-55 years, having educational qualification from middle standard to graduation level and from technical and non-technical trades. It has included both married and unmarried, Male and female cases. They were belonging to three religions (Hindu, Muslim and Sikh). The sample characteristics have been shown in Table I. Design All of the fifty cases of GAD were randomly distributed for two modes of treatment i.e. 25 in each Medicines and Bio-Feed Back therapy groups. Their 70 Sarkar et al

progress was measured on objective and projective tools, before and after both therapies, with their fortnightly follow-ups. Standard course of treatment was given to both group. Table 1 Sample Characteristics Age (yrs) M F Education M F 51 - Above - Graduates 41 – 50 Higher Secondary (10+2) - 31 – 40 High School (10 thh) 21 – 30 Middle (8 thh) Total (50) Total (50) Trades M F Religions M F Marital Status M F Technical – Hindu Married Non-Technical Muslim – Unmarried Others Sikh Divorced Total (50) Total (50) Total (50) Instruments Used To assess the effects of Pharmacotherapy and Bio-feed back therapy among GAD cases, following psychological tests were used : 1. Hamilton Anxiety Rating Scale (HARS) 2. Somatic Inkblot Series (SIS –I) 1. Hamilton Anxiety Rating Scale The Hamilton Anxiety Rating Scale (Hamilton, 1959) is an objective instrument which rates degree of state anxiety on four points rating scale, in fourteen major Psycho-somatic areas viz Anxious mood, Somatic–Muscular and Sensory, Cardiovascular symptoms, Respiratory symptoms, Gastrointestinal and Genito Urinary symptoms, Autonomic Symptoms and Behaviour. It (HARS) has been quite popular among physicians and psychiatrists, while interviewing their patients. It is quite a reliable and a valid instrument. Efficacy of Psychotherapy 71

2. Somatic Inkblot Series – I The Somatic Inkblot Series – I (Cassell, 1980) is the latest addition in the family of Ink-blot techniques. It consists of 20 cards, in black and white and gray coloured ink blot images on each card. There are enough images giving representation of body organs, anatomical body parts and human contents. The test is to be administered individually, by putting all cards infront of the subject or patient and he is asked to select the three most anxiety producing/ threatening cards, out of them. What does he or she see on them and why they look to be threatening, what do the images remind him or her of ? Later, the subject has to give his/her responses on remaining cards. By doing so much can be learned about the subjects areas of disturbance, anxiety and therapeutic planning by the Psychiatrist, Psychologist and Nursing officer. It rates the degree of anxiety quantitatively as well as qualitatively. Procedure All of the 50 cases were first interviewed by the Psychiatrist using the criteria in vogue. The patients with confirmed diagnosis of the GAD, using ICD – 10, were randomly divided between two groups, before initiating any mode of treatment i.e. Pharmacotherapy and Bio-Feed Back therapy. Then they were interviewed and rated on HARS by Psychiatrist and assessed with the help of SIS – I by a Clinical Psychologist. The protocols of both tests were scored as per standard instructions given in their respective Mannuals. The SIS-I protocols were scored on six quality of response i.e. total time and responses, reaction time per card typical and atypical responses and five contents like anatomy, sex, human, animal and other contents. The responses were further rated on four pathological contents rating scales viz PAS, HAS, D & P to judge the degree of Pathology in their contents. Their HARS protocols were scored on 14 Major Psycho-somatic areas. Their progress were measured before and after both therapies along with their fortnightly follow-up. Statistical Analysis of Data After scoring of protocols of both objective and projective psychological tests, the Means and S. D.s of each variable were calculated. Then significance of mean difference between pre and post treatment conditions of both modes of treatment was analyzed using t-test. The result of the study obtained in this way have been shown in the following tables and discussed in the light of previous findings. 72 Sarkar et al

Results After statistical analysis of the data obtained from GAD cases treated with Pharmaco-Therapy and Bio-feed back therapy, following results were obtained. The table II reveals the significances of means difference of HARS scores between pre and post treatment conditions of both groups of GAD cases. The t- values (t : 4.76, sig. .01) reveal the significance of mean difference of HARS score in pharmacotherapy group pre and post treatment conditions. It indicates that symptoms of GAD were significantly decreased from pre to post treatment condition with the help of medicines given to them. In the same manner, the t- value of BFB group (t : 3.16) was also found to be significant at .01 level, which clearly demonstrate that the patients of GAD who were treated with BFB therapy, did show significant improvement in their symptoms (generalised anxiety). The present findings are in the accordance with the previous observations made by Rickel et, al, (1987), Biswas et, al, (1995) and Broota et, al, (1995) Mitra & Mukhopadhaya (1996). Table 2 Significance of Mean Difference of HARS Scores between Pre and Post Treatment Condition of GAD Cases in both Groups Conditions Modes of Pre-treat- 1 st 2 nd Post treat- t-value Therapies ment Follow up Follow up ment Pharmaco M 20.44 16.44 9.28 5.2 4.76 *** Therapy SD 10.84 7.19 6.49 3.42 BFB M 15.76 12.28 7.04 5.53 Therapy SD 10.61 10.32 7.25 6.60 3.16 ** Note : *** t-value significant at .001 level. ** t-value significant at .01 level. The table III reveals the mean and SD’s of SIS – I variables of GAD cases treated with Pharmaco and BFB therapy. The significance of mean difference on 4 SIS variables, out of 12 such variables, show the improvement in their Efficacy of Psychotherapy 73

quality of responses (behaviour) on SIS – I test, before and after treatment conditions of both groups. It can be observed from the table – III that there was a significant decrease in the ‘total time taken’ to complete the test between first and fourth assessment in both groups, as is shown by their t-values (t : 2.22) sig. At .05 level (phar) and t-value 2.09 sig. At .05 level (BFB). It was initially high, which decreased gradually, as he felt relaxed from his/her GAD symptoms. The t-value of both groups i.e. phar. And BFB were also observed to be sig. at desirable levels (t : 2.96 & t : 2.78, sig. at .01 level, both). It indicates that it is not only the total time, but the ART per card also, which gets decreased, as the patient feels relaxed from his/her GAD symptoms, with both therapies. The same pattern was observed in previous studies (Cassell, 1980, 1996, 1997, Dubey, et. al. 1994). In addition to their total time and ART per card, the difference was also seen on their unexpected quality of responses i.e. a typical responses. The t-value of both groups (t : 2.15 ‘Phar.’ & t : 7.21 ‘BFB’) were observed to be sig. at .05 and .01 levels, respectively. It reveals that, as the patient feels comfortable with effect of either medicines or BFB, he gives lower unexpected responses from pre to post treatment conditions. The BFB group, in addition to above, showed significant changes in their pathological contents of responses after taking a suitable course of BFB therapy. However, the same was not seen in their counterparts (Phar. Group). This change may be attributed to their personal unique feelings after having particular experiences with BFB therapy. The other variables such as total number of responses, typical responses and rejection of cards and all of five contents remained unchanged in both groups between two conditions i.e. pre and post treatment conditions. The findings of present study revealed the significant changes in their means of HARS, and response pattern i.e. total time, ART per card, atypical perception and pathological contents of responses, confirm the previous observations made in this fields, except the last one i.e. pathological contents (Saldanha & Dubey 1994, Dubey 1994, Dubey et, al, 1995 ; Mitra & Mukhopadhaya 1996 : Gayatri & Kallapan 1997 : Pershad, et. al. 1997). 74 Sarkar et al

Table 3 Significance of Mean Differences of SIS – I Variables between Pre and Post Treatment Conditions of GAD Cases in both Groups Group Conditions SIS – I Modes of Pre- 1 st 2 nd Post tr- t-value Variables Therapies treatment Followup Followup eatment Phar. M 20.08 21.32 21.14 21.2 0.48 SD 6.91 16.04 5.19 3.46 ns Total Responses BFB M 20.92 22.12 24.18 23.15 0.92 SD 7.37 5.46 6.36 4.19 ns Phar. M 19.4 15.08 14.95 13.5 SD 7.97 5.77 5.95 3.90 2.22 * Total Times(Mts.) BFB M 16.0 12.8 12.97 11.92 SD 6.48 6.09 5.16 3.69 2.09 * Phar. M 17.09 12.59 9.81 9.59 2.96 * SD 8.79 4.59 5.46 0.88 ART (Sec) per card BFB M 19.12 10.60 8.66 7.57 2.78 ** SD 9.73 3.93 2.41 3.05 Phar. M 7.48 7.72 8.14 8.4 0.79 SD 2.72 4.18 4.0 3.98 ns Typical Responses BFB M 10.04 11.04 12.36 13.46 1.96 SD 4.77 3.8 3.91 3.91 Phar. M 3.28 3.04 2.80 1.38 2.15 * SD 2.50 2.40 2.08 2.8 Atypical-Phar Responses BFB M 3.08 3.28 3.27 2.07 7.21 ** SD 1.21 1.89 2.11 1.38 Phar. M 5.08 5.72 5.14 6.10 0.60 SD 4.73 4.18 3.78 3.94 ns Anatomy Contents BFB M 5.52 5.56 6.95 5.69 0.17 SD 3.02 3.37 3.86 2.78 ns Phar. M 1.68 1.88 1.71 1.3 1.08 SD 2.15 2.53 2.0 1.14 ns Sex Contents BFB M 3.04 3.48 3.54 4.15 0.92 SD 3.88 3.25 2.74 2.68 ns Phar. M 3.92 3.56 3.66 4.00 0.07 SD 2.15 2.53 2.0 1.17 ns Human Contents BFB M 4.04 4.20 4.59 5.15 1.98 SD 1.68 1.61 1.80 1.56 ns Phar. M 5.96 6.69 6.85 6.7 0.51 SD 4.21 4.88 4.05 2.75 ns Animal Contents BFB M 4.68 6.00 6.22 5.30 0.61 SD 3.13 3.2 3.02 2.61 ns Phar. M 3.60 3.00 4.09 3.5 0.09 SD 2.88 3.81 3.12 2.41 ns Other Contents BFB M 3.6 3.28 3.27 2.92 0.61 SD 3.53 2.68 2.68 2.13 ns Phar. M 1.56 1.04 0.48 1.30 0.33 SD 2.41 1.53 1.05 0.9 ns Pathological BFB M 0.64 0.08 0.81 3.58 7.17 *** Contents SD 1.32 1.2 1.23 1.0 Phar. M 5.32 4.44 3.62 3.4 1.72 SD 3.28 5.47 3.09 2.0 ns Rejection Phar. Of Cards BFB M 4.48 3.4 2.09 2.30 1.86 SD 4.0 3.50 2.33 1.85 ns Efficacy of Psychotherapy 75

Conclusion It can be concluded that both therapies i.e. Phar. and BFB show significant role in reducing the symptoms of generalized anxiety disorder, as revealed in the objective scores of HARS, as well as in the qualitative changes in response pattern of the SIS–I. However, the present study and findings leave the importance of a projective test for the qualitative assessment in their improvement after any mode of treatment. So it is clear that the symptoms are reduced and the hypothesis is retained. References Barrios, B. A. and Shigetomi, C.C. (1979) Copying Skill Training for Management of Anxiety, A Critical Review. Behav. Therapy, 10, 491-522. Biswas, Arpita, Biswas, D. and Chattopadhya R.K., (1995) Cognitive Behaviour Therapy in Generalized Anxiety Disorders, Ind. Sr. Cit. Psy., vol 22 (2) 1-10. Bruta, Aruna; Verma, Ruchi & Singh, Archana (1995) Role of Relaxation in Hypertension, Jr. Ind. App. Psy. Chd., 21(1) 29-36. Butler, G.; Fennel, M.; Robson, P. & Gelder, M. (1991) ; Comparison of Behaviour Therapy and Cognitive Therapy in Treatment of Generalised Anxiety Disorder. Jr. Consult. Chd Psy. 59, 167-175. Cassell, W. A. (1980) SIS-I and Body Simbolism. SIS Center, Anchorage, Alaska, USA. Dosajh, N. L. (1995) A New Combination of Therapies for Treatment of Schizophernics of Less Than Five Years Duration. SIS J. Proj. Psy. & Ment. Health, 2 : 135-138. Dosajh, N. L. (1996) Projective Techniques With Special Reference to Inkblot, SIS J. Proj. Psy. & Mental Health, 3 : 59-68. Dosajh, N. L. (1997) Some Experiences With Somatic Inkblot Series, SIS J. Pro. Psy. & Mental Health, vol 4 : 25-33. Dubey, B. L., Mishra, M., Dwivedi, C.B. & Mishra, N. (1994) Diagnosis and Therapeutic Utility of SIS – II, and Rorscach, SIS J. Pro. Psy. & Ment. Health, 1: 19-26. Dubey, B. L., Cassell, W. A., Dwivedi, P. & Mishra, N. (1995) Inner Cry Through Somatic Inkblot Series, SIS J. Proj. Psy. & Ment. Health, 2: 119-128. Gayatri Devi, S. & Kalliapan, K. V. (1997) Improvement of Psychosomatic Disorders Among Tension And Headache Subjects using Behaviour Therapy & Somatic Inkblot Series. Hamilton, M. (1959) The Assessment of Anxiety State by Rating Br. J. Med. Psy., 432-52-55. Hutchings, D.F., Denney, D. R. Basgall, J. & Housatn, B. K. (1980) Anxiety Management and Applied Relaxation in Reducing Generalised Anxiety Disorder. Behav. Research 18: 181-190. 76 Sarkar et al

Jarrel, R. B. & Rush, A. J. (1988) Congnitive Therapy for Panic Disorder and Generalized Anxiety Disorders. Cognitive Psychotherapy. Theory and Practice. Springar – Verlag, New York. Jerath, J. M., Hasija Sudershan & Dalip, M. (1993) A Study of State Anxiety Scores in Problem Solving Situation. Studies Psychologies. 35: 143-146. Mitra, G. & Mukhopadhaya, A. (1996) SIS and Social Anxiety. An Assessment of Personality Factor of Drug Addicts. SIS J. Proj. Psy. & Ment. Health, 3: 153-164. Pershad, D. & Verma, S. K. (1995) Dignostic Significant of Content Analysis of SIS – II. SIS J. Proj. Psy. & Ment. Health, 2 : 139-144. Pershad, D., Verma, S. K. & Bhagat, K. (1997) Body Image Disturbances in Psychiatric Cases, Raskin, M., Ball, I.R. & Packe, H. V. (1980) Muscle Bio Feed Back T M and Controlled Evaluation of Efficiency in the Treatment of Chronic Anxiety. Arch. Gen. Psychiat, 37, 93-97. Rathee, S. P., Goel, D. S., Saldanha, D., Chawala, M. L. & Dubey, B. L. (1994) A Study of Somatic Inkblot Series – I in Coronary Cases. SIS J. Proj. Psy. & Ment Health, 1:51-64. Rickles, K., Scheitzer, E. & Lucki, I. (1987) Benzodiazepam Side Effects. Psychiatric Update. APA. Annual Review. American Psychiatric Press. Washington. DC 781-801. Saldanha, D. & Dubey, B. L. (1994) Efficacy of Sodium Pentothol on SIS Video. SIS J. Proj. Psy. & Ment. Health, 2 : 19-28. Singh A. R. and Banerjee K. R. (1996) Efficacy of SIS – II in discriminating OCD patients and normals. SIS J. Proj. Psy. & Ment. Health, 3 : 165-169. Suinn, R. M. & Richardson, F. (1971) Anxiety Management Training A Non-Specific Behaviour Therapy Programme for Anxiety Control. Behaviour Therapy,. 2 : 498-510. Telch, M. J., Teaumon, B., Tyalor, C. B. (1983) Combined Pharmacological and Behavioural Treatment for Agrophobia. Behaviour Res. Therapy, 22 : 325-335. Woodward & Jones (1980) Cognitive Restructuring Treatment; A Controlled trail With Anxious Patients. Beh. Res. & Therapy, 18 : 401-407. Efficacy of Psychotherapy 77 APPEAL Members of Somatic Inkblot Society are requested to kindly send their Annual dues before the 31st of January each year, to enable the Society to meet its expenses and smooth publication of the Journal.

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)

Somatic Inkblot Society (MEMBERSHIP DIRECTORY - 1999) S. Alam, Ph.D. Lecturer, Dept. of Psychology, Women's College, Aligarh Muslim University, Aligarh-202002 (India) (LM 97) Ms. Zahirunnisa Ali Specialist in Physical Therapy, Plot No. 65, Ayppa Nagar, P.O. Katol Road, Nagpur Tel. : 91-712-539418 (LM 95) Ms. Anjali, Ph.D. Lecturer 2D, Drummond Road, Allahabad. (India). (M 96) Phillip. W. Baker, Ed.D. 4325, Laurel, Suit 215, Anchorage, AK 99508 (USA) Res. : 2305 Susitna Dr. Anchorage, AK 99517 (USA) Tel. : (907) 562-2392 (W) (907) 243-8042 (H) (M 95) E-Mail : wcbaker@alaska.net Mrs. Shubhra Banerjee, Ph.D. "Shubhalaya", 7, Mahaveer Colony, Kamachha, Varanasi - 221 010, (India) (LM 97) Tel. : 91-542-312049 (H) Ms. Jayanti Basu, Ph.D. Consultant Psychologist AE 692, Salt Lake, Sector 1, Calcutta - 700 064, (India) Tel. : 91-33-341421, 3379772 (H) (LM 95) Saugata Basu, M.Sc, M.Phil. Clinical Psychologist. Surendranath Cooperative, 201, Manikatala Main Road, # 12, Calcutta - 700 054, (India) Tel. : 91-33-3379772 (H) (LM 97) Mrs. Nalini Bhanot, Ph.D. Lecturer in Sociology, C/O Advocate Anuj Bhanot Chakia, Varanasi - 232103 (India) Tel. : 91-5413-22267, (FM 94) Mahesh Bhargava, Ph.D. Director, National Psychological Corporation, 4/230, Kacherighat, Agra - 282 004 (India) (LM 95) Tel. : 91-562-350 113 (H) Mrs. Mary Cassell, Executive Director 4105, Tudor Center Drive, B-6, Anchorage, Alaska - 99508 (USA). Tel. : 907-562-2400 (W) Fax : 907-563-3746 (W) (FM92) E-Mail : drcassell@corecom.net E-Mial : marycassell@hotmail.com Wilfred A. Cassell, MD, FAPA, APC, Director, SIS Center, President Somatic Inkblot Society, 4105, Tudor Center Drive, B-6, Anchorage, Alaska - 99508 (USA). Tel. : 907-562-2400 (W) Fax : 907-563-3746 (W) (FM 92) E-Mail : drcassell@corecom.net Lt. Col. S. Chaudhury, MD, Ph.D. Psychiatrist, Command Hospital (N.C.) C/o 56 APO (India) (LM 95) Tel. : 91-1992-86539. Sebestian Chembakam, Ph.D. Consultant Clinical Psychologist, Kalavathu Road, Palarivattom, Cochin-682025 (India) Tel. : 91-484-336162 (LM 96) Alfred Collins, Ph.D. Consultant Clinical Psychologist 615 East, 82nd Ave, Suite 102, Anchorage, Alaska - 99518 (USA) Tel. : (907)-344-3338 (W) Fax : (907)-346-4084 (H) (LM 95) Commandant, Command Hospital (WC) Chandimandir - 134107, Haryana (LM 97) Mrs. Pratibha Dhondia, M.A. 1352, Sector 34-C, Chandigarh - 160 034. Tel. : 91-172-664562 (H) (LM 97) Neeraj Shayam Deo, DMSP C/o Dr. S. R. Deo, Gandhi Chowk, Jalna - 421203 (India) (M 98) Tel. : 91-252- 225445 (W), 33831 (H) N. L. Dosajh, Ph.D. 1121, Sector 15-B, Chandigarh - 160 015. Tel. : 91-172-772651 (H) (LM 95) Director, Agra Mansik Arogyashala, Agra - 282002 (India) (M 98-99)

Anand Dubey, B.E., MBA (Final Year), Joint Editor, Dept. of Business Administration Alaska Pacific University, 4101 Uni. Drive, Anchorage, AK 99508 (USA) LM E-Mail : adubey@hotmail.com Bankey L. Dubey, Ph.D. Director SIS Center India, Vice President Somatic Inkblot Society, Mailing Add. : P.O. Box 1107, Sector 15 Post Office, Chandigarh - 160 015 (India) Res. : T-II/15, Sector 25, Chandigarh - 160 014 Tel. : 91-172-710985, Tel./Fax : 91-172-710986 (FM 92) E-Mail : sisdubey@ch1.dot.net.in Rajan Dutta, M.P.M.I.R. General Manager, Sprint RPG India, A-49, Amar Colony, Lajpat Nagar (West), New Delhi - 110 024, (India) (LM 95) Tel. : 91-11-6218833, 6863172 (H) Mrs. Padma Dwivedi, M.A. Secretary Somatic Inkblot Society, Social Worker, Dept. of Cardiology, Post Graduate Medical Institute, Chandigarh - 160 012, (India) (FM 92) Tel. : 91-172-710985, 710986 E-Mail : sisdubey@ch1.dot.net.in K. L. Garg, MD Consultant Neuro-Psychiatrist SCO-6, 1st Floor, Sector 17-E, Chandigarh - 160 017 (India) (LM 95) Tel. : 91-172-702281 (W) 564800 (H) Ms. Suveena Garg 1001, Sector 4, Panchkula, Haryana (India) (M 98) Amool Singh Grewal 179, Sector 11-A, Chandigarh-160011 (India) (M 98) Tel. : 91-172-547179 Ravikant Gunthey, Ph.D. A-111, Shastri Nagar, Jodhpur-342003 (India) (LM 96) Tel. : 91-291-33943 (H) 622755 (W) Ms. Sarita Gupta, M.A. Research Scholar, University Business School, Panjab University, Chandigarh (India) (M 96) Chief Librarian, Haryana Inst. of Public Administration, 76 Sector 18, Gurgaon, (Haryana) Mukesh K. Jha, M.A. Dept. Dept. of Yoga Psychology, Bihar Yoga Bharati, Ganga Darshan, Munger - 811201, Bihar (India) (LM 97) Tel. : 91-6344-22430 (W) (M 97) M. R. Jhanwar, DPM Consultant Neuro Psychiatrist, Deva Institute of Mental Health, B-27/70, Barhal Kothi, Durga Kund, Varanasi - 221 005. (India) (LM 94) Tel. : 91-542-310670 (W) Lt. Col. T. Rajan John, MD. Dept. of Psychiatry, Command Hospital (NC) C/O 56 APO. (LM 97) Tel. : 91-1992-86539 (W), 71775 (H) Walter Stanley Johnson, Ph.D. Tri-Cities Chaplaincy, 2108 W, Entiat Avenue, Kennewick, WA 99336-3000 (USA) (M 97) Tel. : (509) 783-7416 (W), 628-034 (H) R. K. Joshi, DM & SP Consultant Clinical Psychologist, B-27/70, Barhal Kothi, Durga Kund, Varanasi - 221 005, (India) Tel. : 91-542-310670 (W) (LM 94) Ms. Harpreet Kaur, M.Phil Clinical Psychologist, Dept. of Psychiatry Govt. Medical College & Hospital, Sector 32, Chandigarh (India) (LM 98) Rajinder P. Kaur, Ph.D. Social Scientist, Dept. of Psychiatry, PGIMER, Chandigarh - 160012 (INDIA) (LM 98) Pradeep K. Khatri, Ph.D. Sector-H, C-53, Aliganj, Lucknow - 226020 (India) (M 97) Tel. : 91-522-371065 (H) Darshan K. Khera, DPM Bank of India, Sec. 17-B, Chandigarh - 160017 (LM 96) Anatoly Khromov N6, Micr, VI apt. 163, Kurgan, Russia - 640023 Tel. : 007-352-2-485740 (H) E-Mail : khromov@zaural.ru 80 Directory

Mrs. Rohini Khullar 22 A, Ring Road, Lajpat Nagar-IV, New Delhi - 110 024 (India) (LM 95) Tel. : 91-11-6434121, 6225695 (H) A. S. Kundu, Ph.D. Indian Council of Medical Research, Ansari Nagar, New Delhi - 110 029 Tel. : 91-11-653980 (W) (FM 94) Amresh Kumar C/o Anup Lal Yadav, Vill-Lagma, P.O. Shivkund, Distt. Munger, Bihar. (M 99) Ashwani Kumar C/o Vishnu Maya Sapkota, Milan Chowk, Butwal - 11, (Nepal) Tel. : 71-42048 (M 98) Mr. Navin Kumar S/o Mr. Mahesh Prasad Sah, Vill.-Paria, P.O. Bariarpur, Distt. Munger - 811211 Bihar (INDIA) (M 908) Rakesh Kumar, Ph.D. Sr. Clinical Psychologist, Agra Mansik Arogyashala, Agra-282002 (India) (LM 98) Tel. : 91-562-322650 Fax : 322648 Yatnesh Kumar 367 Chandra Prabha Niketan, Lallo Pokhar, Munger-811201 Bihar (India) Tel. : 91-6344-22021 (H) (M 98) Librarian, Bhavnagar University Library, University Campus, Gijubhai Badheka Marg, Bhavanagar - 364002 (India) (M 98) Librarian, H.P. University, Shimla (India) (M 98) Librarian, Tilak Dhari College, Jaunpur, UP (India) (M 98) Librarian, School of Public Health Libraray, 42 Warren Hall, # 7360, Berkely, CA 94720-7360 (USA) Librarian, Prestige Institute of Management & Research, 2 Education & Health Sector, Scheme 54,Indore - 452010 (India) Ph. : 91-731-557510 Fax : 554274 E-Mail : pimrind@bom4.vsnl.net.in H. N. Mahto, Ph.D. Head, PG Dept. of Psychology, LN. Mithila University, Kameshwar Nagar, Durbhanga-846004 Bihar (India) (M 97-2001) Seema Malhotra, Ph.D. Asst. Prof. in Clinical Psychology, Dept. of Psychiatry, Kasturba Medical College, Manipal-576 119 Karnataka (India) (LM 95) L. Sam Manickam, Ph.D. Director, Center for Applied Psy. Studies (CAPS) Baith Shalom, Thirupuram, Thiruvananthapuram - 695133 (India) (LM 97) Tel. : 91-471-260148 (H), 443587 (W) B. P. Mishra, Ph.D. Dept. of Psychiatry, Dayanand Medical College & Hospital, Ludhiana - 141001 (India) Res. : 481, College Road, Oppo, Kitty Bakery, Civil Lines, Ludhiana - 141001 Tel. : 91-161-471634 (LM 95) Ms. Mridula Mishra, Ph.D. Treasurer, Somatic Inkblot Society, Consultant Clinical Psychologist, 196, Saket Colony, Naria, Varanasi - 221 005 (India) (FM 94) Tel. : 91-542 - 312703 (H) Mrs. Nishi Misra, DM & SP Scientist 'B' 19 SSB, SCE, Allahabad - 1, Res. : 25, Ashok Nagar, Allahabad - 1, (India) (LM 95) P. K. Mishra, Ph.D. Reader, Center for Advance Studies in Psychology, Utkal University, Bhubaneswar-751004 (India) (LM 97) Tel. : 91-674-583286 (H) 581739 (W) P. N. Mishra, Ph.D. Executive Director, Center for Entrepreneur Development M.P. 60, Jail Road, Jehangirabad, Bhopal - 462008 (India) (LM 94) Tel/Fax : 91-755-574772 (W) Sunil Mittal, M.D. Consultant Psychiatrist, Delhi Psychiatry Center, 35 Defence Enclave, Vikas Nagar, Delhi - 110 092, (India) (LM 95) Tel. : 91-11-2214726 (W) 2222767 (H) Mrs. Reetinder Mohan, Ph.D. 269, Sec. 16-A, Chandigarh - 160016 (India) (LM 97) Tel. : 91-172-770269, 781026 Directory 81

S. Ramachandra, Ph.D. Addl. Professor (NIMHANS) 292, 2nd Main, 3rd Phase, J.P. Nagar, Bangalore - 560 078. (India) (LM 94) Tel. : 91-80-6641267 (H) Ankush Randhawa 1612, Sector 38-B, Chandigarh - 160036 (India) (M 98) Tel. : 91-172-691813 Dalbir Kaur Randhawa, DM&SP, 1106, Sec. 33-C, Chandigarh (India) (LM 97) Tel. : 91-172-615774 (H) S. P. Rathee, M.A. Dept. of Psychiatry, Command Hospital (WC), Chandi Mandir Cantt -134 107. Haryana (India) Tel. : 91-172-866574 (W) (LM 94) Readmore Inc. 22 Cortland Street, New York, NY 10007 (USA) Tel. : 212-349-5540 Ferro Roberto, Ph.D. Consultant Clinical Psychologist, Via Bernardino Bellincione -14, 20134 MILANO (ITALY), (M 95) Tel. : 39-2-2154874 (H) Gilbert J. Roth, D. Min. 62, Timmerman Drive, Richland, WA-99352 (USA). (M 94) Tel./Fax : (509) 628-2132 (H) E-Mail : gil@owt.com M. Sahay, Ph.D. Clinical Psychologist, 95, Doctors Apartments, 4, Vasundhara Enclave, Delhi - 110096 (India) (FM 94) Tel. : 91-11-2488489 (H) Capt. Mrs. Jyothi Sakaleshpur, DPN, Military Hospital, Meerut-250001 (M 97) D. Saldanha, DM Consultant Psychiatrist, Command Hospital (E.C.) Alipore, Calcutta (India) (LM 94) Mrs. Amandeep K. Sandhu, MPMIR Tej Form, Manimajra, Chandigarh-160101 Tel. : 91-172-740991 (H) 782135 (W) Col P. Sarkar, MD. Psychiatrist, Military Hospital, Tejpur (INDIA) (M 98) Ms. Anjana Mukhopadhyay, Ph.D. Dept. of Psychology, Women's College, Banaras Hindu University, Varanasi - 221 005 (India) Tel. : 91-542-310206 (H) (LM 94) Bernard I, Murstein, Ph.D. Dept. of Psychology, Connecticut College, Box - 5581, New London, CT-06320-4196 (USA). (LM 94) Tel. (203) 442-1816 (H) Fax : 203-439-2700 (W) Ashima Nehra, Ph.D. 5175/1, Modern Housing Complex Manimajra, Chandigarh-160101 (India) Tel. : 91-172-553055 (H) (LM 96) K. N. Ojha, Assitt. Director, N.I.M.H. Regional Trg. Center, Kasturba Niketan, Lajpat Nagar - II, New Delhi - 110 024, (India) (LM 95) Tel. : 91-11-6831012 (W) 6840233 (H) Ann M. O'Roark, Ph.D. 866, Amelia Coart, NE St. Petersburg, Fl 33702-2784 (USA) (M 98) Tel/Fax : (813) 527-9863 E-Mail : AnnMORoark@aol.com Rakesh Pandey, Ph.D. Dept. of Psychology, Deen Dyal Upadhyay, Gorakhpur University, Gorakhpur. (India) (M 94) Lt. Col. Vijay Pandey, MD, Psychiatrist, Dept. of Psychiatry, Military Hospital, Ahmedabad-380003, (India) (M 95) Paul E. Panek, Ph.D. Associate Dean, OSU Newark Campus, 1179, Uni. Drive, Newark, Ohio-43055, USA. (M 98) Tel. : (614) 366-9315 E-Mail : panek.1@osu.edu Lt. Col. S. S. Panglia, MD Consultant Physician, 1446, Phase-10, SAS Nagar, Mohali (Near Chandigarh) Distt. Ropar (India) Tel. : 91-172-675536 (H) (LM 94) Sheetala Prasad, Ph.D. Lecturer in Psy., Ewing Christian College, Allahabad-211008 Tel. : 91-532-613363 (H) (M 95) Raja Ram, Ph.D. General Manager, Montari Industries Ltd., A-98, Sector-IV, Noida Phase-I. (UP) (India) Tel. : 91-11-8952158 (W) (M 95) 82 Directory

George Savage, M.Sc. Consultant Clinical Psychologist, Cape Tecknikon, P.O. Box - 652, Cape Town - 2000 (South Africa) (LM 95) Fax : (27) 21-454-161, 461-7564 Tel. : (27) 21-72-1281 (H). 460-3536 (W) D. D. Sharma 5206/3, Modern Residential Complex, Manimajra, Chandigarh-160101 (India) G. C. Sharma, Ph.D., Director, 1400, Heller Dr. Yardley, PA-19067-2041 (USA) Tel. : (215) 295-3099 (W) Tel. : (215) 493-2006 (H) (M 95) Harish K. Sharma, M.Phil. Lecturer in Psychology, SBS (M) College, Kotkapura, Punjab (India) (LM 97) Hemant K. Sharma, Ph. D. Hemant Mansion, Near Haveli Barkat Sahib, Nai Sarak, Jodhpur -342001 (India) Tel. : 91-291-54088 (H). 22755 (LM 96) Narendra K. Sharma, Ph.D. Dean Academic Affairs, Prof. of Psychology, 4055. Type-IV, P.O.-IIT, Kanpur-208016 (India) (LM 98) Fax : 91-512-590260 E-Mail : doac@iitk.ernet.in Mrs. Abhilashita Singh, Ph.D. S-17/331, 'D' Maldahia, Varanasi - 221 001. (India) Tel. : 91-542-47067 (H) (LM 95) Agyajit Singh, Ph.D. 136, Civil Lines, Patiala. (INDIA) (LM 97) Tel. : 91-175-72797 Amool Ranjan Singh, Ph.D. Clinical Psychologist, Mental Hospital, Kanke, Ranchi, Bihar (India) (LM 95) Anup K. Singh C/o Mrs. Kanta Balangir, At Sagur Para, P.O. Belangir, Distt. Belangir - 767001 (Orissa) (M 98) D. P. Singh, MPMIR, Group Exe. Vice President, Montari Industries Ltd., 78 Nehru Palace, New Delhi - 110 019. (INDIA) Tel. : 91-11-6436175 (H) (LM 95) M. P. Singh, M. Phil Lecturer in Psychology, 1329, Sec. 70, Guru Teg Bahadur Complex, Mohali (Near Chandigarh) (INDIA) Tel. : 91-1675-20583 (W) Tel. : 91-172-223658 (H) (LM 95) Navneet Singh, M. P. M. & I.R. General Manager, Modi Olivetti, 98, Hemkunt Tower, 13th Floor, New Delhi - 110 019. (India) (LM 95) Tel. : 91-11-6530592 (W) 2252737 (H) Mr. Pawan Kumar Singh C/o Mr. R. N. Sinha, Radha Rani Sinha Road, Jalla Kothi, Machak Chak, Bhagalpur -812001, Bihar (India) (M 98) Tel. : 424309 (H) Col. Rajinder Singh. MD Consultant Psychiatrist, 1734, Sec. 33-D, Chandigarh - 160 047 (India) Tel. : 91-172-600694 (H) (LM 96) Col. Rajinder Singh Management Consultant, 1526, Sector 34-D, Chandigarh, (India) Tel. : 91-172-601398 (H) (LM 98) Sanjay K. Singh (Atma Bindo) Bihar Yoga Bharati, Munger Fort, Munger - 811201 Bihar, (India) (M 98) Tel. : 91-6344-22469 Fax : 20169 Mrs. Saraswati Singh. Ph.D. 9, Block G. Teg Bahadur Road, Dehradun - 248001 (INDIA) Tel. : 91-135-622276 (M 97) Tejbir Singh, 3207, Sec. 28-D, Chandigarh - 160002 (India) Tel. : 91-172-651498 (H) (M97) Virender Singh, MPM & IR Vill. & P.O. Bir Banga, Distt. Kaithal, Haryana (India) (M 98) Miss. Shipra Srivastava, MA. 10/34, Indra Nagar, Lucknow - 226016 (India) (M 97) Mrs. Ruby Talukdar, MA. 24 SSB. Selection Center South, Cubbon Road, Bangalore - 560042 (India) Tel. : 91-80-5168813 (H) (M 97) Technical Library & Documentation, Indian Farmers Fertilisers Cooperatives Ltd. (IFFCO) Aonla Unit, P.O. IFFCO Township, Bareilly - 243403 (M 97) Directory 83

Ms. Vandana Tewari, MA. E-3142, Raja Ji Puram, Lucknow (India) (M 96) Ailo Uhinki, Ps.D., Ed.I., Psykologitoimisto, Synteesi, Linnankatu-37 aA 9, Fin-20100 Turku, Finland Tel. : +358-(0)2-232 2001 Fax : +358 - (0)2-232 5007 E-Mail : a.uhinki@synteesi.inet.fi De-Cicero Emidio Vaz. Ph.D. Av. Lajeado. 969 AP. 301, Porto Alegre, R.S. Brazil, Brazil - 90460-110 (M 96) Tel. : 501-3344235 (W) Kiran Bala Verma, Ph.D. Head Dept. of Psychology, Harishchandra PG College, Varanasi - 221001 (India) (M 98) Tel. : (0542) 332042 (W) 32031 (H) S. K. Verma, Ph.D. 5522, Modern Housing Complex Manimajra, Chandigarh - 160 101 (India) Tel. : 91-172-712892 (H) (FM 95) Sanjay Vohra, MA. Psy-Com Services, B-4, 80/2, Safadurjung Enclave, New Delhi-110029 (India) (LM 95) Tel. : 91-11-6106433 Fax : 91-11-6175191 N. Kumar Yaduvanshi, DPM. CMO, TPT Bn. ITBP, Airport Chandigarh - 160003 (India) (LM 98) Tel. : 91-172-640182 S. Yuvraj, Ph.D. Asstt. Prof. in Psychology 12, NITIE Qrts., NITIE, Vihar Lake Bombay-400087 (India) (LM 99) Tel. : 91-22-857337 Fax : 857325 E-Mail : Prog@nitie.ernet.in Consultants K. R. Banerjee, FAPA, MRCP, Supdt. Mental Hospital, Kanke, Ranchi, Bihar (India) R. S. Basi, Ph.D. Professor, Dept. of Management, Alaska Pacific University, 4101 Univ. Drive, Anchorage, Alaska - 99508. (USA) Tel. : 907-345-6655 (H) J. C. Bubber, MBA General Manager (HRD), Punjab Alkalies & Chemicals Ltd., SCO 125-127, Sector 17-B, Chandigarh Tel. : 91-172-713823 (W), 742628 (H) Anna Laura Comunian, Ph.D. University Degli Studi di Padova. Departimento Di Psicologia Generale, Via Venezia. 8. 35131, Padova (ITALY) Prof. C. B. Dwivedi, Ph.D. Dept. of Psychology, Banaras Hindu University, Vanarasi - 221 005 (India) Tel. : 91-542-317430 (H) Justice G.C. Garg Punjab & Haryana High Court, 502, Sector 16-C, Chandigarh (INDIA) Tel. : 91-172-549072, 549879 (H) Ron Ginsberg 353 Carlton Drive, Chapel Hill NC 27516 (USA) Tel. : 919-967-9558 (H) K. V. Kaliappan, Ph.D. Professor, Dept. of Psychology, University of Madras, Madras - 600005 (India) Tel. : 91-44-6260571 (H) Mr. Raj Kumar, IAS 286, Sector 16-C, Chandugarh-160016 Tel. : 91-172-549036 Les Nyman, MD. 6600 Jollipan Court, Anchorage, AK-99516 Tel. : 907346-3375 (H) Z. Mahmood. Ph.D. 5 Boclair Ave. Bearsden. Glasgow, G 61 2 SE, Scotland, (UK) Tel. : 041-942-8748 (H) Barry A. Ritzler, Ph.D. Dept. of Psychology, Long Island University, University Plaza, Brooklyn NY 11201 (USA) Tel. : (718) 488 - 1068 (W), (201) 327-1292 (H) David Sperbech, Ph.D. 2530, De Barr Road, Anchorage Alaska - 99508. (USA) M. K. Tewari, MS. M.Ch. Consultant Neuro-Surgeon, Dept. of Neurosurgery, Post Graduate Medical Institute, Chandigarh - 160 012 (INDIA) Tel. : 91-172-545845 (H) H (Home). W (Work). FM (Founder Member) LM (Life Member). M (Member). 84 Directory

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

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) CHIEF EDITOR : B.L. Dubey, Ph.D., Director SIS Center India, 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.dot.net.in OR sisdubey@hotmail.com EDITORS : Wilfred A. Cassell, MD, Director, SIS 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 (INDIA) : C. B. Dwivedi, Ph.D., Prof. Dept. of Psychology, Banaras Hindu University, Varanasi-221005 (INDIA) Tel. : 91-542-317430 : Gilbert J. Roth, D. Min., 62 Timmerman Drive, Richland, WA-99352 (USA). Tel./Fax : (509) 628-2132 (H) E-Mail : gil@owt.com : S. K. Verma, Consultant in Clinical Psychology, Govt. Medical College and Hospital, Sector 32, Chandigarh. JOINT EDITORS : Mrs. Padma Dwivedi, M.A., Social Worker, Dept. of Cardiology, P.G.I.M.E.R., Chandigarh-160 012 : A. Dubey, Somatic Inkblot Center, P.O. Box 1107, Sector-15, P.O., Chandigarh - 160 015 ASST. EDITOR : M.P. Singh, M.Phil, Lecturer, Desh Bhagat College, Dhuri, Sangrur, Punjab (INDIA) : Ms. Mridula Mishra, Ph.D., Lecturer, Bihar Yoga Bharati, Munger-811201 (INDIA) Tel. : 91-6344-22430 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 Justice G.C. Garg, India Ron Ginsberg, U.S.A. Ravi Kant Gunthey, Ph.D., India K.V. Kaliappan, Ph.D., India Anatoly B. 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, SIS Center, 4105 Tudor Center Dr. 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 Les Nyman, MD. U.S.A. K.N. Ojha, Ph.D., India Paul E. Panek, Ph.D., U.S.A. 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. M. Sahay, Ph.D., India George Savage, M.Sc., S. Africa Hemant K. Sharma, Ph.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 Regd. with Registrar of News Paper for India Regd. No. S/Del/93/TC Dt. 22.9.93