SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 11 Number 2 July, 2004 SIS ISSN 0971 - 6610 Vol. 11, No. 2, Pgs. 73-140 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 2004

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is a refereed journal and published twice a year (January, July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counseling, cross-cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION: Manuscripts should be typewritten (doublespaced throughout) submitted in duplicate to B.L. Dubey, Ph.D. Editor in Chief,SIS Journal, Post Box 1107, Sector-15 Post Office, Chandigarh 160015 (India). E-mail:sisdubey@rediffmail.com. Manuscript can also be submitted to Wilfred A. Cassell. M.D., Editor, 4501 East, 104th Avenue, Anchorage, AK-99516 (USA). E-mail: siscassell@yahoo.com. The Editors reserve the right to refuse manuscript submitted and to make minor additions/deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment SUBSCRIPTION: The journal is free to members of the Society, Annual membership fees are US $40 for foreign members and Rs. 250, for Indian members, Institutional subscriptions are US $60. for Foreign institutions and Rs. 500 for Indian institutions. Life membership is US $300. for foreign members and Rs. 2000/- for Indian members. Non-members may subscribe for $30 or Rs. 150 per issue. Cheques should be made payable to ‘SOMATIC INKBLOT SOCIETY’ Chandigarh and should reach Dr. B.L. Dubey, Editor in Chief, (Address given above). Please add $5./Rs.70/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform Mrs Padma Dwivedi, Treasurer, Somatic Inkblot Society, Post Box 1107, Sector- 15 Post Office, Chandigarh - 160015 (India), Tel/Fax 91 - 172 - 2710986, Email: sisdubey@rediffmail.com and Foreign Members should inform Mr.Anand Dubey Editor, 4240 Edinburgh Drive, Anchorage, AK - 99502 (U.S.A.) Tel:(907) 344-0350, Email: adubey@hotmail.com of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT CENTER, India/Anchorage U.S.A. Website: http://www.somaticinkblots.com

SIS Journal of Projective Psychology & Mental Health Volume 11, Number 2, July 2004 Contents Page Nos. 1. Editorial : SIS Lessons, Wilfred A. Cassell 73-74 2. Substance Dependence, General Mental Health and Somatization 75-84 Responses: A Study of Ganja Smokers, Tobacco Smokers and Non-Smokers, Jayanti Basu and Rahul Nandy 3. Special Scores of Rorschach Comprehensive System in 85-90 Schizophrenia and Mania : A Comparative Study, Ranjeet Kumar and C.R.J. Khess. 4. Comparative Study of SIS-I Indices Between Schizophrenic and 91-94 Manic Patients, S. Kumar, R.Singh and S.Mohanty 5. A Nervous System Based Model for SIS Inkblot Projection and 95-104 Consultation, Wilfred A. Cassell and Bankey L. Dubey 6. Emotional Profile in the Context of Depression, Anxiety, 105-114 Aggression & Adjustment of Epileptic & Non-Epileptic Adolescents: A Comparative Study, Nilanjana Sanyal and Priyanka Banerjee 7. Role of Somatic Inkblot Series in Psycho Sexual Disorder in 115-120 India, B.L. Dubey, Ajith, C., Somesh Gupta and Bhushan Kumar 8. SIS with Physically Disabled Adolescents, Dr. Ramjee Lal 121-123 9. Psychometric Evaluation of a Short Form of Holtzman Inkblot 124-132 Technique, C. R. Darolia and H. L. Joshi 10. Second Announcement of SIS Conference 133-136 11. Book Review, Uma Vasudeva 137-138

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, Director, Somatic Inkblot Center, President, Somatic Inkblot Society, Editor, SIS Journal of Proj. Psy. & Mental Health, 4501E, 104th Avenue, Anchorage, AK 99516 USA. E-Mail : siscassell@yahoo.com Web Site at http: //www.somaticinkblots.com OR B. L. Dubey, Ph.D., DPM, Editor in Chief, SIS Jr. of Proj. Psy. & Mental Health, Director Somatic Inkblot Center India, P.O. Box 1107, Sector 15 Post Office, Chandgarh-160015 Tele/Fax : 91-172-2710986, Mob.: 91-9417036655 E-mail : sisdubey@rediffmail.com

Editorial SIS Lessons We live in an ever more dangerous and fragmented world. Authoritarian based ideologies too frequently clash with scientific based reality. Vast sums are internationally squandered on defense and military budgets. Throughout the ages astronomical numbers of individuals have been traumatized by war. Our SIS society has a responsibility in preparing future world leaders. Early in education students can be shown how the mechanism of projection can shape and sometimes even drastically distort their subjective impressions. They might become less vulnerable to demagogic religious and political leaders who as a rationalization for aggression promote projecting negative characteristics onto others. Selected SIS images may also be introduced in classrooms as an aide for educating students about individual differences in cognition and emotion. This educational aide could foster greater confidence in accepting the validity of their own views, while simultaneously fostering respect for opinions of others. This projective lesson might well be introduced in the morning schedule when many will still be marginally conscious of affect charged dreams. The day residual of these will still be intruding upon awareness and disrupting their ability to focus on traditional classroom work. Sometimes teachers refer these to clinicians who misdiagnose such concentration problems as symptoms of so-called Attention Deficit Disorder. In this poorly understood syndrome, difficulty in assessment is compounded by a student’s reluctance to share such emotionally painful imagery. Also, memories of their traumatic dreams may largely be blocked from conscious recall. Clearly it is not the role of the teacher to therapeutically process this material. However, superficially discussing morning SIS responses will publicly identify the student’s inner world as an important dimension of psyche life. Of course, there will be resistance to this educational approach. There is substantial controversy regarding the validity and reliability of projective response assessment measures, as well as the significance of dreams. Consequently, educators might make a few introductory comments about the history of knowledge in these fields as in the following suggested language: “Early humans knew little about their biological and psychological natures. While we now know much more in these areas, we still live in a world with many unknowns. Most subjects taught in school are based on relatively solid factual information. However, sometimes you may be exposed to softer areas of study that are more illusive, less scientifically substantiated – but highly interesting! Scientists generally prefer to move from the known to the peripheries of knowledge. Sometimes, such as in inkblot and dream research, curious investigators may even attempt to explore mysterious aspects of our inner lives and perceptions. As humans

we are physically encased in a fragile body. Our physical abode is ever changing. These changes can sometimes cause adjustment problems. Perhaps some of you currently may be experiencing these as you adjust to puberty and adolescence. Later in life there are other potentially stressful changes as the body passes through the various passages of the human life cycle prior to death. A few fortunate members of this class some of which after completion of their university training may become behavioral scientists. They will have the opportunity to explore the many remaining puzzling life questions. Some may be able to be involved in fascinating research concerning what influences how we think and feel, like in this morning’s lesson. Please be curious concerning what the inkblots remind you of and how they make you feel. Then write the number of each SIS inkblot and your responses. You may keep these private, or later share them with others. As you participate in this mental exercise, portions of your brain will be activated. Memories could be aroused of your past outer world, as well as your inner life of imagery and dreams.” Next the class will be shown selected socially acceptable SIS images (i.e. nonsexual) in one of the various forms available. After the teacher has again reassured them about their right to privacy, a general discussion on their response styles may follow. Next two students will be asked to come forward for role-playing. One will be assigned the stage part of a professional interviewer; the other the client/patient in the manner of a psychodrama. These volunteers can read from various clinical transcripts from the SIS literature. A classroom scene could be acted out reenacting a professional interview examining SIS responses of a law enforcement officer or military combatant suffering from Posttraumatic Stress Disorder etc. After this example, the teacher might lead them to examine how certain stressful life events and occupations make for vulnerability to traumatic dreams and health problems. The instructor would be well advised to end the discussion by showing the debriefing session in the SIS-II video and computer monitor versions. The overall discussion might well include reference to the hypnotic relaxing flowers and their healing significance. Other techniques such as Yoga and related forms of meditation might also be introduced to put the SIS technology in intellectual context historically. In such a SIS lesson, educators could establish in each student’s mind the importance of accepting a reverence for their subjective inner world experiences and a life long empathy for others. Wilfred A.Cassell, M.D., FAPA APC. Director SIS Center, 4501E, 104th Ave, Anchorage, AK-99516(USA) Email: siscassell@yahoo.com 74 Cassell

Substance Dependence, General Mental Health and Somatization Responses : A Study of Ganja Smokers, Tobacco Smokers and Non- Smokers Jayanti Basu and Rahul Nandy The study compared thirty male Ganja (cannabis) dependent, thirty tobacco dependent and thirty non-smoker adults of Kolkata. They were individually administered the General Health Questionnaire – 28 and SIS-I . Results indicated that the non-smokers had the least general mental distress as well as the highest scores on the positive indices on SIS-I. Among the negative indices however, the non-smoker group also scored high in Animal, Anatomy and Sex responses. They scored the lowest in two negative indices of mental health, namely, Atypical responses and Rejection of images. The Ganja and tobacco smokers shared some of the somatization responses . However the tobacco smoker group could utilize the social resources to a greater extent than the Ganja smokers. The results have been explained in terms of the intrinsic nature of the two drugs as well as with reference to the legal and social acceptability status of Ganja and tobacco as agents of dependence. The present study compares the somatization responses to projective material of men having two categories of substance-dependence with a ‘normal’ comparison group. Substance dependence may take different forms – here smokers of two types of substances were used. One group of men consisted of the users of a legal and socially acceptable drug – nicotine; they habitually smoke cigarettes. The natural source of nicotine is tobacco plant or Nicotiana tabacum. An estimated world-wide death toll with nicotine abuse is around three million (Peto et al., 1996). The other group consists of those who use an illegal drug – that is ganja (cannabis); this group contains persons who smoke cannabis leaves through cigarettes or clay container (kolke). Its main ingredient is marijuana or delta-9- tetrahydrocannabinol. Cannabis use, particularly for those starting around adolescence has been associated with social and psychiatric morbidity (about 54%) as well as with use of alcohol and other illicit drugs (Kandel, 1984; Regier et al., 1990; Weiss, 1992; Kessler et al., 1997). Enhanced occurrences of comorbid anxiety and depression leading in a considerable percentage to suicidal behaviour with cannabis use have been amply reported (Berman and Schwartz, 1990; Burke et al., 1994; Fergusson and Horwood, 1997). Substance dependence may be described as a psychological compulsion to change the internal chemistry of the body and thereby altering mental states. Indeed, the psychopathology of substance dependence is a multifactorial issue (Scourfield et al., 1996) that centres around the complex interaction of genetic predisposition (Bergen et al., 1999; Arinami et al., 2000), familial and other environmental influences (Coombs and Landsuerk, 1988; Miles et al., 1998) and personality deviance including personality disorders (Bornstein, 1992; de Wit and Bodker, 1994). Other studies have demonstrated Jayanti Basu, Ph.D. Reader and Rahul Nandy, Research Scholar, Dept. of Applied Psychology, Calcutta University, 92 APC Road, Kolkata 700009. E-mail : jaybc@rediffmail.com Key words: SIS-I, cannabis, nicotine, substance dependence

that the substance dependent and non-dependent persons differ in stable cognitive characteristics like field dependence (Barnes, 1979) and locus of control (Rosenow, 1982). Being a meeting ground of the psychological and physiological components in its symptomatology and aetiology, substance dependence serves as an excellent experimental ground for studying the interaction of the mind and the body. With this consideration in mind the present research focussed on the somatization responses of substance dependent persons. Somatization responses are the perceptual responses related to the body. These responses represent the hidden, unconscious and repressed responses regarding the different internal and external organs or parts of the body (soma). Therefore, somatization responses, particularly when expressed through projective material, serves as an avenue of the distressed person to express the unconscious anxiety regarding one’s body and the inner cry for help. (Cassell, 1977; Dubey et al., 1995). While substance dependence is the expression of a vulnerable psychological and biological condition, its management defies direct intervention and entails multiple relapses. There are a few reasons for this. Substance abuse is mediated by multiple mechanisms in the brain, having both reward value as well as reduction of unpleasantness (Blum and Nobel, 1991). Dependence therefore serves as a kind of coping mechanism and is maintained in the form of ‘self-medication’ associated with management of anxiety and tension (Weiss et al., 1992; Murphy and Khantzian, 1995). Thus a vicious cycle is created for the dependence prone person. It is in this second context that the legality and social acceptability of drugs becomes a pertinent issue with significant ethical, social and medical implications. Dependent persons, with their genetic and psychological vulnerability gain further from the positive feedback from dependence that at the same time alleviates internal distress. This in turn is coupled with social justification, contribute to sustenance of dependent behaviour and enhance the probability of ultimate psycho -physiological damage. The present study purports to compare the degree of distress and the nature of somatization responses among the three categories of persons (dependent tobacco smokers, dependent ganja smokers and non-smokers) and infer the psychosomatic communication of the smokers as revealed through their dependence. The selected mode of investigation has been the recording of responses on the Somatic Inkblot Series Test, as it is known to stimulate body imageries in response to unstructured stimuli (Cassell, 1980). A series of earlier studies have demonstrated the difference in somatization responses between substance abusers and non-abusers, many of them being conducted in India (Gaetani et al., 1995; Mukhopadhyay et al., 1996; Mitra and Mukhopadhyay 1996, 2000; Banerjee et al., 1998). The findings from the studies have generally demonstrated greater pathology among dependent persons, although overlap in certain areas with the normal comparison group has been noted. It has further been found that somatization patterns differ between different groups of substance users, thus supporting a probable agent-specific physiological and genetic sensitivity among the dependent persons (Swan et al, 1996). 76 Basu & Nandy

Methods: Participants: The participants were Bengali Hindu Middle class males between the ages of 20 and 30 and with minimum Secondary standard education. The two target groups were (1) thirty Ganja smokers, who have been consuming cannabis at least 10 times a day for the past 2 years and (2) thirty nicotine smokers who consume 25 or more tobacco cigarettes per day. An initial interview revealed that they were psychologically dependent on the substance and felt extremely uneasy if it was withdrawn. The comparison group consisted of thirty men of comparable background, but those who have never smoked cigarettes or are not dependent on any other substance. However, they drink coffee or tea in moderate amount. The cannabis dependent group was contacted through a drug-de-addiction centre where they have been referred for the first time for intervention. The data were collected on admission to the organization, but before any chemical intervention has been made. At the time of data collection all participants were free from any immediate effect of cannabis. It was also ensured that they did not regularly abuse other kinds of drug or alcohol, though the history of occasional indulgence in mixed kinds of substance could not be eliminated. The other two groups were collected through purposive sampling technique from the general population with an eye to demographical comparability with the cannabis dependent group. Measures: The measures used were 1. Personal Information Schedule: This schedule contained, apart from social and demographical variables, a detailed enquiry about the smoking habit and other kinds of dependence. 2. Somatic Inkblot Series-I by Cassell (1980): It contains 20 cards with black and white, grey and red inkblots on them. Most of the cards comprise of forms symbolizing anatomical structure and these are supposed to mobilize unconscious perception of body and concerns about it. The responses can be interpreted qualitatively as well as quantitatively. It yields 10 quantitative indices, namely Total Responses(R), Human Responses (H), Animal Responses (A), Anatomical Responses (At), Sex Responses (Sex), Movement Responses(M), Most Typical Responses(MT), Typical Responses (T), Atypical Responses(AT) and Rejection of Images(Rej). The test further yields four pathological responses, which were not used for the present study. The utility of the test for diagnostic, prognostic and therapeutic purposes has been systematically reported (Dosajh, 1998; Dubey and Cassell, 2000; Cassell and Dubey, 2004). 3. General Health Questionnaire – 28 by Goldberg and Hiller (1979) It is a 28 item scale with 4 subdivisions. The total score reflects the degree of distress owing to somatic preoccupation, anxiety and depression. A Bengali adaptation of the scale has been used in the present study (Basu and Dasgupta, 1996). Collection of data and analyses: Data were collected individually from each participant. The cannabis users were tested within the clinic situation while the nicotine smokers and the non-smokers were tested at their respective homes. Time to administer all the tests took on the average 30 minutes. Quantitative scoring of SIS-I based on number of Substance Dependence and Somatization 77

each category of responses to the cards was done. GHQ-28 was scored according to the manual. Descriptive statistics for each of the ten SIS-I variables as well as the GHQ-28 score were calculated. Subsequently, One Way Analysis of Variance was computed to determine whether each of these eleven variables differed among the three groups. Post-hoc t tests were conducted to compute between group differences. Table 1 Means. Standard Deviations and F Values for the 10 SIS-I and GHQ-28 Responses Dependent Variables Statistic Ganja Tobacco Non- F Value Smokers Smokers Smokers Total Responses M 44.10 53.53 64.83 19.05** SD 14.30 10.07 14.25 Human Responses M 7.17 9.53 11.13 5.92** SD 4.83 3.51 4.99 Animal Responses M 8.33 10.80 16.37 11.50** SD 7.55 4.32 7.54 Anatomical Responses M 10.63 11.77 14.03 3.53* SD 4.95 3.10 6.49 Sex Responses M 3.13 1.80 3.53 4.43* SD 2.79 1.40 2.65 Movement Responses M 0.97 1.60 2.23 6.25** SD 1.40 1.28 1.48 Most Typical Responses M 1.93 3.80 4.10 10.12** SD 1.68 2.46 1.84 Typical Responses M 4.60 7.00 11.13 29.13** SD 2.22 2.67 4.66 Atypical Responses M 7.33 7.23 2.30 19.89** SD 4.46 3.69 1.99 Rejection of Images M 1.63 1.50 0.13 5.20** SD 1.52 3.07 0.43 GHQ M 4.73 4.27 1.73 11.31** SD 3.19 2.56 1.82 **p<0.01 and *p<0.05 with df 2,87 78 Basu & Nandy

Results: The means and standard deviations of the SIS-I scores and the GHQ-28 scores for the three groups are presented in Table 1. The table reveals that the non-smoker group had the highest scores in R, H, A, At, Sex, M, MT and T responses. This group scored the lowest in AT and Rej scores. The non-smoker group also scored the lowest on GHQ-28 scale. The tobacco dependent group scored the lowest in Sex responses, and was in-between the non-smoker and the Ganja-smoker groups for all other categories. The Ganja smoker group scored the lowest in R, H, A, At, M, MT and T and the highest in AT and Rej responses. They scored second highest in Sex responses. The same table also shows the results of One-way ANOVAs for each variable. It is observed that the three groups differed among themselves in all variables, as the F values were significant in each response category. Subsequently, post-hoc t tests were conducted to find out whether the three groups differed from each other in somatization and distress. The results are presented in Table2. Table 2 Pair Wise Comparison with ‘t’ test Between the Cannabis Smokers, Nicotine Smokers and Nnon-Smokers Dependent variables T values between T values between T values between Ganja and tobacco Ganja smokers & tobacco smokers smokers non-smokers & non-smokers Total Responses -2.95** -5.62** -3.55** Human Responses -2.17* -3.13** -1.44 Animal Responses -1.55 - 4.12** -3.51** Anatomical Responses -1.06 -2.28* -1.72 Sex Responses 2.34* -0.57 -3.17** Movement Responses -1.83 -3.41** -1.78 Most Typical Responses -3.44** -4.76** -0.54 Typical Responses -3.79** -6.93** -4.22** Atypical Responses 0.09 5.65** 6.45** Rejection of Images 0.21 5.20** 2.41* GHQ 1.05 6.82** 6.65** **p<0.01 and *p<0.05 with df 58 It is observed that for the SIS variables, the non-smokers differed significantly from the Ganja smokers in all but sex responses. The non-smokers differed from the tobacco Substance Dependence and Somatization 79

smokers in terms of R, A, Sex, T, AT and Rej. They were comparable on the response categories of H, At, M and MT. The two categories of substance dependent persons differed in terms of R, H, Sex, MT and T responses. They were similar in At, M, AT and Rej scores. For the GHQ-28 variable, the non-smokers scored significantly less than the other two categories. Discussion and Conclusions: The GHQ scores clearly reveal that the non-smoker group was the least distressed one among the three categories. The two substance dependent groups were comparable in their distress irrespective of the drug taken. Thus, the earlier findings of poor mental health in the substance dependent individuals is replicated here. Of greater interest however, is the fact that the legal and social acceptance of the drug did not influence the degree of pathology. Since GHQ is a measure of overall distress including anxiety, depression, suicidality and somatic complaint, it may be suggested that overall psychological dysfunction is an associate of the dependence itself, and the choice of drug comes only as a later corollary. The difference among the groups in various categories of responses on SIS tests can be understood in terms of their positive or negative implication in mental health (Cassell and Dubey, 1998). The three pairs differed from each other in terms of Total responses (R). Usually, R suggests the imaginative capacity and functional intelligence of the respondent. The results reveal that this quality was possessed in greater amount in the non-smokers. But, here the tobacco abusers were in a better frame of functionality than the Ganja smokers. This difference may be related to either or both of the two factors. One is the difference in genetic and neural pathways involved in the processing of different drugs (Arinami et al., 2000; Uhl et al., 2001). Nicotine falls in the stimulant class of drugs, while cannabis is psychogenic and causes major cognitive and affective changes. Both however share some core mechanism by way of utilizing predominantly the dopaminergic mechanism in the brain (Mirza et al., 1996; Ameri, 1999). The other is the social cause of accepting the nicotine dependent persons within the ‘normal’ arena of social existence. Human responses (H) were significantly lower in the Ganja dependent group in comparison to both the non-smokers and the tobacco smokers, while the latter two did not differ between themselves. H responses deal with the quality and quantity of social and interpersonal relationships and are therefore disturbed in the group of substance abusers that use illicit drugs. At the same time, Movement responses (M) indicate the degree of movement in human beings. It was observed that non-smokers in this regard differed from Ganja smokers, while the tobacco smokers did not differ significantly from either. Thus, while the tobacco smokers had the ability to maintain human relationship, their flexibility and ease in such relationship may be restricted. The findings are in congruence with the earlier studies that have highlighted the social anxiety in illicit substance abusers (Mitra and Mukhopadhyay, 1996). 80 Basu & Nandy

The Most typical responses (MT) are indicative of coherent, logical thinking and the capacity to cope with the demands of the society. This again is another measure of interpersonal quality and here also the users of the illicit drug scored significantly lower than the other two groups who were either non-dependent or dependent on an accepted substance. Typical responses (T) like R or GHQ scores indicate overall mental wellness and here again the three groups differed significantly from each other, and in the expected direction. Atypical responses (AT) and Rejection of images (Rej) suggest presence of psychiatric pathology. Here the two substance dependent groups shared cores, both having psychological dysfunctions, while the non-dependent group was significantly superior. The findings so far are more or less consistent with the earlier findings on SIS with substance dependence and congruent with expectation (Kumar, 2000). Some other findings however were surprising. Animal responses (A), Sex responses (Sex) and Anatomical responses (At) are usually associated with negative indices of mental health. The A responses suggests immaturity, the At responses are usually indicative of poor self image and preoccupation with internal body organs and Sex responses are related to sexual anxiety (Cassell and Dubey, 1998). Based on this, one might expect that such responses would be lower in the normal sample and higher in the substance dependent groups, particularly in the face of the fact that immaturity and obsessive concern with body and sexuality including eating disorders often characterize substance dependence (Abraham, 1960; Helen and Frank, 1990; Varner, 1995; Kubetin, 2001). The present findings evinced to the contrary. Animal responses were higher in the non-smokers as were Anatomy responses. The most confusing results were for Sex responses, where the non-smokers and Ganja smokers were similar and both of them differed significantly from the tobacco smokers. While it is not possible to forward any definite theoretical justification at the moment, it may be recalled that some earlier findings have also recorded such anomalies. For example, Banerjee et al. (1998) obtained higher A and At responses in the normals in comparison to the heroin abusers. While, it is always possible that such anomalous results came from sample fluctuation, there remains the possibility that limitations of the quantitative scoring have contributed at least partially to the results. While qualitative analysis of a projective test is an all-time choice for the researcher, the quantitative treatment also needs to be developed. It may be suggested that the quantitative scoring of SIS needs more exploration, as its parameters are as yet rather direct and simple. Although a number of earlier studies have demonstrated the utility of quantitative indices of SIS in diagnosis and therapeutic planning, even in comparison to Rorschach (Kaur and Verma, 1998), it still lacks the complex relationships as have been involved in Rorschach scoring. Probably use of percentages and ratios of the various indicators would have provided a more realistic picture of the test and enhance its clinical application. Substance Dependence and Somatization 81

Despite the fact that all the results were not in accordance with the theoretical expectation, it may be stated in conclusion that the SIS revealed certain interesting patterns to compare among the two substance dependent and the non-dependent groups. The most significant finding was the fact that while the two substance dependent groups shared cores in psychiatric morbidity, the coping mechanism for the two differed, particularly in using the interpersonal resources in tobacco users. One therapeutic implication of the findings is that therapeutic modes counting predominantly upon interpersonal relationships, (for example Client centred therapy), may be utilized with sensitive situation-specific modification for substance dependent persons. References: Abraham, K. (1960). The Psychological Relation Between Sexuality and Alcoholism. In K. Abraham. Selected papers of Karl Abraham. New York: Basic Books. Ameri, A. (1999). The Effects of Cannabinoids on the Brain. Pharmacoogical and Biochemical Behaviour, 64(2):257-60 Arinami, T., Ishiguro, H. & Onaivi, E. S. (2000). Polymorphisms in Genes Involved in Neurotransmission in Relation to Smoking. European Journal of Pharmacology, 410, 215-226. Banerjee, S., Mukhopadhyay, A. & Singh, U. (1998). An Indepth Study of Somatization in Heroin Addicts through SIS-I and Rorschach Inkblot Test. SIS Journal of Projective Psychology and Mental Health, 5, 33-39. Barnes, G. E. (1979). The Alcoholic Personality: A Reanalysis of the Literature. Journal of Studies on Alcohol, 40, 571-634. Basu, S. & Dasgupta, S.K. (1996). Adapted Bengali Version of General Health Questionnaire – 28. Kolkata. Dept. of Applied Psychology, Calcutta University. Bergen, A. W., Korczak, J. F., Weissbecker, K. A. et al. (1999). A Genome-wide Search for loci Contributing to Smoking and Alcoholism. Genetic Epidemiology, 17 Suppl 1), S55-S60. Berman, A. & Schwartz, R. (1990). Suicide Attempts Among Adolescent Drug Users. American Journal of Disorder in Childhood, 144, 310-314. Blum, K. & Nobel, P. (1991). “Genes, Messengers and Addictive Behavior.” Addiction and Recovery, Reprint, Nov/Dec, 3-9. Bornstein, R. F. (1992). The Dependent Personality: Development, Social, and Clinical Perspectives. Psychological Bulletin, 112, 3-23. Burke, J. D., Burke, K.C.& Rae, D.S. (1994). Increased Rates of Drug Abuse and Dependence After Onset of Mood or Anxiety Disorders in Adolescence. Hospital and Community Psychiatry, 45, 541-555. Cassell, W.A. & Dubey, B.L. (1998). Application of Somatic Inkblot Series in Personality Assessment, Diagnosis, Screening and Therapy. SIS Journal of Projective Psychology and Mental Health, 5, 3-32. Cassell, W.A. & Dubey, B.L. (2004). Somatic Inkblot Series: Historical Background and Earlier Projects. SIS Journal of Projective Psychology and Mental Health, 11, 11-18. 82 Basu & Nandy

Cassell, W.A. (1977). Desensitization Therapy for Body Image Anxiety. Canadian Psychiatric Association Journal, 22, 239-242. Cassell, W.A. (1980). Body Symbolism and the Somatic Inkblot Series. Anchorage. Alaska. Aurora Publishing. Coombs, R. H. & Landsuerk, J. (1988). Parenting Styles and Substance Use During Childhood and Adolescence, Journal of Marriage and the Family, 50, 473-482. de Wit, H. & Bodker, B. (1994). Personality and Drug Preferences in Normal Volunteers. International Journal of the Addictions, 29, 1617-1630. Dosajh, N.L. (1998). Somatic Inkblot Series – An Excellent Psychodiagnostic Tool. SIS Journal of Projective Psychology and Mental Health, 5, 136-138. Dubey, B.L. & Cassell, W.A. (2000). Inkblot Responses as an Aid to Therapy. SIS Journal of Projective Psychology and Mental Health, 7, 3-10. Dubey, B.L., Cassell, W.A., Dwivedi, P. & Mishra, M. (1995). Inner cry Through Somatic Inkblot Series. Journal of Projective Psychology and Mental Health, 2, 119-128. Fergusson, D.M. & Horwood, L. J. (1997). Early Onset Cannabis Use and Psychosocial Adjustment in Young Adults. Addiction, 92, 279-296. Gaetani, G., Fiorenzo, L., Alfio, L. et al. (1995). Corporal Perception in HIV Positive and Negative Heroin Addicts Assesse with Somatic Inkblot Series-I. SIS Journal of Projective Psychology and Mental Health, 2, 119-128. Goldberg, D.P. & Hiller, V.E. (1979). A Scaled Version of the General Health Questionnaire. Psychological Medicine, 9, 139-146 Helen, E. R. & Frank I. (1999). Binge Eating and Substance Use Among Male and Female Adolescents, International Journal of Eating Disorders, 26, 245-260. Kandel, D.B. (1984). Marijuana Users in Young Adulthood. Archives of General Psychiatry, 41, 200-209. Kaur, R.P. & Verma. S.K. (1998). A Correlatinal Study of Selected Rorschaxch and SIS II Variables in Psychiatric Patients. SIS Journal of Projective Psychology and Mental Health, 5, 15-118. Kessler, R.C., Crum, R.M., Warner, L.A. et al. (1997). Lifetime Co-occurrence of DSM III-R Alcohol Abuse and Dependence with Other Psychiatric Disorders in the National Comorbidity Survey. Archives of General Psychiatry, 54, 313-321. Kubetin,S. K. (2001). Eating Disorders and Substance Abuse. http://www.findarticles.com/cf_dls/ m0CYD/11_36/76444564/p1/article.jhtml. OB/GYN News, June 1. Kumar, R. (2000). Meta Analysis of the Findings in SIS-II. SIS Journal of Projective Psychology and Mental Health, 7, 141-147. Miles, D., Stallings. M., Young, S. et al. (1998). A Family History and Direct Interview Study of the Familial Aggregation of Substance Abuse: the Adolescent Substance Abuse Study. Drug and Alcohol Dependence, 49, 105-114. Mirza, N., Pei, Q., Stolerman, I., Zetterstrom, T. (1996). The Nicotine Receptor Agonists -Nicotine and Isoarecolone Differ in their Effects on Dopamine Release in the Nucleus Accumbens. European Journal of Pharmacology, 295, 207-210. Substance Dependence and Somatization 83

Mitra, G. & Mukhopadhyay, A. (1996). SIS and Social Anxiety – An Assessment of Personality Factors of Drug Addicts. SIS Journal of Projective Psychology and Mental Health, 3, 153-164. Mitra, G. & Mukhopadhyay, A. (2000). Psychological Factors in Drug Addicts and Normals: A Comparative Study. SIS Journal of Projective Psychology and Mental Health, 7, 53-78. Mukhopadhya, A., Banerjee, S & Mitra, G. (1996). A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS Journal of Projective Psychology and Mental Health, 3, 33-41. Murphy, S. L. & Khantzian, E. J. (1995). Addiction as a “Self-medication” Disorder: Application of Ego Psychology to the Treatment of Substance Abuse. In A. Washton (Ed). Psychotherapy and Substance Abuse: a Practitioner’s Handbook. New York: Guilford Publications, Inc. 161-175. Peto, R., Lopez, A. D., Boreham, J., et al. (1996). Mortality from Smoking Worldwide. British Medical Bulletin, 52, 12-21. Regier, D.A., Farmer, M.E.& Rae, D.S. (1990). Comorbidity of Mental Disorders with Alcohol and Other Drug Abuse: Results from the Epidemiologic Catchment Area (ECA) Study. Journal of American Medical Association, 264, 2511-2519. Rohsenow, D. J. (1983). Alcoholics’ Perceptions of Control. In W. M. Cox (Ed.), Identifying and Measuring Alcoholic Personality Characteristics (pp. 37-48). San Francisco: Jossey-Bass. Scourfield, J., Stevens, D., & Merikangas, K. (1996). Substance Abuse, Comorbidity, and Sensa tion Seeking: Gender Differences. Comprehensive Psychiatry, 37, 384-392. Swan, G. E., Carmelli, D. & Cardon, L. R. (1996). The Consumption of Tobacco, Alcohol, and Coffee in Caucasian Male Twins: a Multivariate Genetic Analysis. Journal of Substance Abuse, 8, 19-31. Uhl, G. R. , Liu, Q. R., Walther, D. et al. (2001). Polysubstance Abuse-vulnerability Genes: Genome Scans for Association, Using 1,004 Subjects and 1,494 Single-Nucleotide Polymorphisms. American Journal of Human Genetics, 69, 1290-1300. Varner, l. (1995). Dual Diagnosis: Patients with Eating and Subatance Related Disorders. Journal of the American Dietic Association, 95, 224- 225. Weiss, R. D., Griffin, M. & Mirin, S. (1992). Drug Abuse as Self-Medication for Depression: an Empirical Study. American Journal of Drug and Alcohol Abuse, 18, 121-129. Weiss, R.D. (1992). The Role of Psychopathology in the Transition from Drug Use to Abuse and Dependence. In Glantz, M. & Pickens, R.(Eds.).Vulnerability to Drug Abuse. A.O.A.: Washington, DC, 137-148. 84 Basu & Nandy

Special Scores of Rorschach Comprehensive System in Schizophrenia and Mania : A Comparative Study Ranjeet Kumar and C.R.J. Khess. Exner’s comprehensive system (CS), unlike the previous scoring systems of Rorschach, developed Schizophrenia Index (SCZI; consisting of empirically derived six special scores) to capture the thought disorder and inaccurate perception thereby aiding the diagnosis of schizophrenia. However, earlier studies had pointed the need to analyze the sensitivity and specificity of these six special scores of the CS in various psychotic conditions to overcome diagnostic problems. The specificity of SCZI for the diagnosis of schizophrenia needs further exploration in as much as thought disorder and inaccurate perception are also found in other psychotic disorders especially, mania. Taking these lacunae into account the present study examined the differential sensitivity of the of special scores of SCZI in discriminating schizophrenia and mania. Patients with the diagnosis of schizophrenia and mania ( N=30 in each diagnostic group) as per the ICD-10 criteria were assessed on Rorschach for the six SCZI indices. Results indicated that deviant responses were highly pathognomic of mania, whereas contamination and incongruous responses were found more in schizophrenic patients. Schizophrenia is considered to be a disorder of thought and perception, which are essentially elicited through clinical assessment. However, at times the task of clinical assessment becomes difficult when the patients are not cooperative. In such conditions, psychological tools were found to be of some help. Noteworthy among them is the Rorschach Inkblot Test (Singer & Brabender, 1993). Though it is not a diagnostic tool it has been widely used for eliciting thought and perceptual disturbances in Indian setting, too. While there are many approaches and systems of the Rorschach test, which provide special scoring indices to capture psychotic symptoms, Comprehensive System of Exner presents a schizophrenia index (SCZI) to facilitate the diagnosis of schizophrenia (Exner, 1991; 1993). The SCZI contains several variables arranged into six empirically derived criteria. If four of these criteria are met in a given protocol, the diagnosis of schizophrenia should be given serious consideration (Exner, 1993). However, many studies have yielded mixed results with this rule. The reason could be that SCZI predominantly captures thought disorder and inaccurate perception; and any psychotic disorder in which these two elements are present might become positive on SCZI. Patients with mania who would exhibit an equivalent degree of thought disorder vis-à-vis schizophrenia tend to be the highest among the false positives on SCZI (Johnston & Holzman, 1979; Schmidt & Fonda, 1954; Singer & Brabender, 1993). Ranjeet Kumar, M.M & S.P., Asst. Professor of Clinical Psychology, Post Graduate Institute of Behavioural and Medical Sciences (Manôpachâr), Raipur (Chattis Garh) (Address for correspondance) E-mail: ran_psy@yahoo.com Fax: 0651-2336668, Phone: 0651-2232618 (W) and C.R.J. Khess, M.D.Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi Key words: Comprehensive System, Mania, Rorschach, Schizophrenia, and Special Scores.

Similarly, schizotypal disorder, borderline personality disorders and bipolar depression were found to be positive on SCZI. These empirical and clinical evidences imply that SCZI lacks diagnostic specificity. Since false positives on SCZI were mainly psychotics suggestion were made to use it as a measure of psychotic process (Meyer, 1993) and further analysis of special scores was thought to be useful in making accurate diagnostic decisions (Exner, 1991; Hilsenroth, Fowler & Padawer, 1998). In Exner’s comprehensive system (Exner, 1993) there are six special scores (to indicate difficulty with cognitive processing) namely, deviant verbalization (DV), deviant response (DR), incongruous combination (INCOM), fabulised combination (FABCOM), contamination (CONTAM) and inappropriate logic (ALOG). DV refers to those answers that create the impression of oddity in the response. DR refers to the responses that may manifest either as ‘inappropriate phrase’ or ‘circumstantial response’ and it includes redundant responses as well as neologism. INCOM refers when blot details are inappropriately merged into a single object. FABCOM is inferred when relationship between two discrete blot details that cannot occur in reality is reported. CONTAM denotes fusion of two or more impressions of one blot area into a single percept that cannot exist. ALOG is scored whenever the subject uses strained reasoning, without any prompting to justify his or her answer. Diagnostic use of the Rorschach in psychiatric patients has, though, generated enormous research, it is remarkable to note the paucity of researches on the diagnostic utility of these special scores in schizophrenia and mania. Exner (1986a, 1986b) reported that patients with schizophrenia would give more of both fabulised combination and incongruous responses. However, this pattern of Rorschach responses has also been found in mania (Johnston & Holzman, 1979; Shenton, Solovay, Holzman, 1987; Solovay, Shenton & Holzman, 1987). The CONTAM responses appear to be pathagnomic of schizophrenia but such responses are rarely observed. Higher incidence of ALOG (54%) reported in schizophrenic patients (n= 320) suggests that this index is more sensitive and specific to schizophrenics or schizophrenic spectrum disorders as compared to contaminated responses. Khadivi and associates (Khadivi et al., 1997) examined the utility of the Rorschach in the differential diagnosis of mania versus schizophrenia and schizoaffective patients and observed that the manic patients displayed significantly more combinatory thinking and affective content than the other two psychotic groups. Hence they suggested a thematic analysis in addition to the analysis of thought disorder contributing to the differential diagnosis of psychotic conditions. From the foregoing review it appears that analysis of special scores would be useful in aiding diagnostic decisions and differentiating schizophrenia from other psychotic conditions, especially bipolar mania. However, there is a dearth of studies to address the differential sensitivity of the six SCZI special scores of the Exner’s Comprehensive System. Taking this gap into account present study makes an attempt to assess the 86 Kumar & Khess

discriminative ability of Exner’s Comprehensive System’s special scores in schizophrenia and mania. Methodology: Sample: Male inpatients of the Central Institute of Psychiatry, Ranchi, aged 18-55 years, with the ICD-10 (World Health Organization, 1992) diagnosis of schizophrenia (n = 30) or bipolar mania with psychotic features (n= 30) were included in the study through non-random sampling method. Patients were diagnosed following a detailed psychiatric interview by a resident doctor, which was then clarified by a senior resident and consultant in psychiatry at outpatient level. Subsequently, the second author verified the diagnoses against ICD-10 Diagnostic Research Criteria (World Health Organization, 1992) before inclusion. Only male patients were included in the study due to low admission rates for women (Khess, Verma, Mukherjee & Das, 1997). Knowledge of Hindi or English, drug naïve or on drugs for not more than a week prior to testing was the inclusion criteria. Patients with any co-morbid psychiatric illness, substance use disorders, neurological and sensory impairments and those who were too disturbed to take test were excluded. Procedure: After informed consent was obtained and rapport was established, the clinical and demographic details were obtained in a semi-structured interview, specially designed for this purpose. First author (RK) administered Rorschach test on all the participants, and scored as per the Exner’s comprehensive system (Exner, 1993). Here it is important to mention that reliable differences have not been obtained between US and Indian norms for the Exner’s comprehensive system (Dhalwal, 2001). Patients’ protocols with 14 responses were included. However, protocols with 12 responses were also included if the lambda was within normal limits. In this study, only the special scores were investigated. A doctoral research scholar in clinical psychology independently scored fifteen randomly selected Rorschach protocols from each group as per the guidelines of Meyer (1999). Analyses: Descriptive statistics (percentages and mean) were computed to describe demographics features of the participants as well as to assess inter-rater agreement of the special scores. Group differences on categorical variables were examined with Chi square test and Fisher exact Test (when cell count was less than five) and independent t test was used to examine the same on continuous variables. Results & Discussion: The composition of the two patients groups was very similar in terms of age and education as the age of Schizophrenic patients (30.86 ± 6.80 years) did not differ Rorschach in Schizophrenia and Mania 87

significantly (p> .05) from that of manic patients (30.96 ± 10.06 years). Similarly in terms of education 73% (n=22) of schizophrenia group and 90% (n= 27) of manic group were literate. The inter-rater agreement for scoring of the special scores was assessed in terms of percent agreement among raters as well as by kappa statistics (Table -1). Results revealed a highly satisfactory inter-rater reliability of the various scoring indices of the Rorschach. Table 1 Interrater Agreement For the Rorschach Special Scores. Segments Observed agreement Kappa- value Interpretation Location and Space .82 .87 Excellent Developmental Quality .94 .90 Excellent Determinants .81 .84 Excellent Form Quality .78 .80 Excellent Special Scores .92 .93 Excellent Table 2 Group Differences In Special Scores of Comprehensive System. Special scores Schizophrenia Mania Chi-square Test n (%) n (%) DR 8 (27) 22 (73) 13.07** DV 15 (50) 18 (60) .61 INCOM 29 (97) 22 (73) 6.41* ALOG 21 (70) 16 (53) 1.76 CONTAM 22 (73) 34.74** FABCOM 12 (40) 11 (37) .07 **Significant at .001 * Significant at .01 Between group comparison it revealed significant differences on deviant, incongruous and contamination responses (Table II). In terms of deviant responses, manic patients (73%) outnumbered the schizophrenic patients (27%). The frequency of deviant responses in schizophrenic group was found to be in the range mentioned by Exner (1986a, 1986b). Further, qualitative analysis indicated that manic patients gave more circumstantial responses characterized by combinatory and playful qualities (Andreasen & Powers, 1974; Wilson, 1985). This finding suggest a theoretically congruent link 88 Kumar & Khess

between the psychopathology of mania and one of the Exner’s special scores, i.e., deviant response inasmuch as deviant responses on Rorschach reflect circumstantial responses (Exner, 1991) and circumstantial responses has been reported to be more prevalent in manic patients than other psychotic groups. Therefore the present observation is in line with the earlier suggestions that thematic analysis in addition to the analysis of thought disorder would enhance diagnostic precision (Khadivi, Wetzler & Wilson, 1997; Singer & Brabender, 1993). In this study, no significant differences were found between schizophrenics (50%) and manics (60%) on deviant verbalizations. Thus it appears that DV reflects brief instances of cognitive mismanagement due to distorted language use or idiosyncratic modes of expression (Exner, 1991). Since in both the conditions such communication deficits are found, we assume that DV may be found in equal degree. However, this finding needs further validation. Though reliable differences were not observed between manic and schizophrenic patients in terms of incongruous responses, such responses were found more in schizophrenics than manics and they were in the range mentioned in the earlier studies (Exner, 1986a; 1986b). Consistent with earlier studies (Hilsenroth, Fowler & Padawer, 1998; Wilson, 1985) significantly higher number of contamination responses (73%) was found in schizophrenic patients. In the present study only schizophrenic scored on this category. Since contamination responses indicate severe thought disturbances, it indicates that thought processes in schizophrenia are more disturbed than the manic patients hence such responses might serve as a marker of psychopathology of schizophrenia. Similarly, 40% of schizophrenics and 33% of manics gave fabulised responses. Though the difference was not significant, it is consistent with earlier studies that fabulised responses can occur more in the records of schizophrenic patients, who are disorganized and primitive (Exner, 1986a; 1986b). Lack of equal representation from all subgroups of schizophrenia is a limitation of the study. Nevertheless, it can be concluded that incongruous combination and contamination responses could be more pathognomic of schizophrenia, while deviant responses are for mania. References: Andreasen, N.C. & Powers, P.S. (1974). Overinclusive Thinking in Mania and Schizophrenia. British Journal of Psychiatry, 125, 452-456. Dhalwal, S.K. (2001). Validity of Depression Index of Exner’s Comprehensive System on Indian Population. Unpublished M.Phil. Dissertation Submitted to Ranchi University, Ranchi, India. Exner, J.E. (1986a). The Future of Rorschach in Personality Assessment. Journal of Personality Assessment, 68, 37-46. Rorschach in Schizophrenia and Mania 89

Exner, J.E. (1986b). Some Rorschach Data Comparing Schizophrenics with Borderline and Schizotypal Personality Disorders. Journal of Personality Assessment, 50, 455-71. Exner, J.E. (1993). The Rorschach: A Comprehensive System Foundation. Vol.1. Basic Foundations (3rd ed.). New York: Wiley. Exner, J.E. (1991). Rorschach Comprehensive System. Vol. 2. Interpretation (2nd ed.). New York: Wiley. Hilsenroth, M.J., Fowler, J.C., & Padawer, J.R. (1998). The Rorschach Schizophrenia Index (SCZI): An Examination of Reliability, Validity and Diagnostic Efficacy. Journal of Personality Assessment, 70, 514-534. Johnston, M. & Holzman, P. (1979). Assessing Schizophrenic Thought. San Francisco: Jossey-Bass. Khadivi, A., Wetzler, S., & Wilson, A. (1997). Manic Indices on the Rorschach. Journal of Personality Assessment, 69, 365-375. Khess, C.R.J., Verma, A.N., Mukerjee, T., & Das, J. (1997). A Comparison of the Demographic Features of Obsessive-Compulsive Disorder and Mania: its Relevance in the Indian Context. . Journal of Personality and Clinical Studies, 13, 81-85. Meyer, G. J. (1993). The Impact of Response Frequency on the Rorschach Constellation Indices and on their Validity with Diagnostic and MMPI-2 Criteria. Journal of Personality Assessment, 60, 153-180. Meyer, G.J. (1999). Simple Procedure to Estimate Chance Agreement and Kappa for the Interrater Reliability of Response Segment Using the Rorschach Comprehensive System. Journal of Personality Assessment, 72, 232-255. Schmidt, H.O. & Fonda, C.P. (1954). Rorschach Scores in the Manic State. Journal of Psychology, 38, 427-437. Shenton, M.E., Solovay, M.R., & Holzman, P.S. (1987). Comparative Studies of Thought Disorder II: Schizoaffective Disorder. Archives of General Psychiatry, 44, 21-30. Singer, H.K. & Barbender, V. (1993). The Use of the Rorschach to Differentiate Unipolar and Bipolar Disorder. Journal of Personality Assessment, 60, 333-335. Solovay, M.R., Shenton, M.E., & Holzman, P.S. (1987). Comparative Studies of Thought Disorder 1. Mania and Schizophrenia. Archives of General Psychiatry, 44, 13-20. Wilson, A. (1985). Boundary Disturbances in Borderline and Psychotic States. Journal of Personality Assessment, 49, 346-355. World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization. World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization. 90 Kumar & Khess

A Comparative Study of SIS-I Indices Between Schizophrenic and Manic Patients S. Kumar, R.Singh and S.Mohanty SIS is a powerful projective instrument and able to discriminate varieties of psychiatric population. The present study is an extension of earlier work comparing schizophrenics and manic patients on Somatic Inkblot Series-I indices. The sample consisted of 30 schizophrenic and 30 manic patients drawn from Institute of Mental Health and Hospital, Agra. A control group of 30 participants was also included for comparison. One-way ANOVA was computed with post hoc comparisons. The results indicated statistically significant differences across the groups. SIS is comparatively a newer addition to the family of inkblots testing. It has renewed the research interest of professionals and has been serving as diagnostic and therapeutic aids. The SIS-I is consisting of 20 images cord form like Rorschach Inkblot Test. The test has been used in diverse population such as Coronary cases (Rathee et al, 1994), Drug addicts (Mukhopadhyay et al , 1996; Banerjee et al, 1998), Psychiatric cases (Cassell and Dubey, 1998, 2003), chronic schizophrenia (Kumar et al 2001) and mania (Kumar et al 2001, 2003). Encouraged by the findings of the earlier studies on SIS-I, the present study is an attempt to compare the indices of SIS-I in schizophrenia, mania and control groups. Material and Method: The sample consisted of 90 participants in three groups: schizophrenia (n=30), mania (n=30) and control (n=30). The clinical groups were drawn from Institute of Mental Health and Hospital, Agra. The psychiatric diagnosis was confirmed through ICD-10 diagnostic criteria. The control group was drawn from general population. The screening of control group was done through GHQ-12 (Goldberg, 1972). The sample characteristics are given in Table-1. SIS-I was administered individually to each participant . The scores on SIS-I indices were converted into percentages for statistical analysis. The data were analyzed through one-way ANOVA with Scheffe’s post hoc comparisons. Results and Discussion: The results of ANOVA and Scheffe’s test are presented in Table 2 and Table 3. Table-2 reveals statistically significant difference for total number of responses, Human responses, Anatomical responses, Movement responses, Most- Typical responses, Typical responses and Rejection of images in three groups of subjects. The significant difference on various indices suggests the discriminating capacity of SIS-I test among various clinical populations. The previous studies on SIS-I have also revealed significant differences in the indices across clinical population such as hospitalized chronic schizophrenia (Kumar et al 2001), manic patients (Kumar et al 2003) and drug addicts (Banerjee et al 1998, Mitra and Mukhopadhyay, 2000). S. Kumar, Director, R.Singh, Medical Superintendent and S.Mohanty, Research Officer, Institute of Mental Health and Hospital, Agra- 282002 (India) E-mail : imhh@sancharnet.in Key Words: SIS-I, Somatic Inkblot Series, Projective Techniques, Schizophrenia, Mania.

Table 1 Sample Characteristics Characteristics Schizophrenia Mania Control Age 34.46±9.48 33.23±8.69 34.78±10.76 Education Upto High School High School + Occupation Nill Service Business Others Marital Status Married Unmarried Family Type Nuclear Joint Table 2 ANOVA for Various Indices of SIS-I in Schizophrenia, Mania and Control SIS-I Indices Sum of df Mean F Sig. Squares Square Total No. of Responses Between Groups 883.267 441.633 12.768 .000 Within Groups 3009.233 34.589 Total 3892.500 Human Responses Between Groups 11458.689 5729.344 15.394 .000 Within Groups 32380.700 372.192 Total 43839.389 Animal Responses Between Groups 128.956 64.478 .287 .751 Within Groups 19556.033 224.782 Total 19684.989 Anatomical Responses Between Groups 2181.089 1090.544 3.247 .044 Within Groups 29222.967 335.896 Total 31404.056 Movement Responses Between Groups 135.089 67.544 4.356 .016 Within Groups 1349.133 15.507 Total 1484.222 Typical Responses Between Groups 260.022 130.011 3.241 .044 Within Groups 3489.767 40.112 Total 3749.789 Typical Responses Between Groups 13136.156 6568.078 37.674 .000 Within Groups 15167.500 174.339 Total 28303.656 Rejection of Images Between Groups 2939.467 1469.733 5.380 .006 Within Groups 23767.433 273.189 Total 26706.900 92 Kumar et al.

Table 3 Post Hoc Scheffe’s Tests in Three Groups SIS-I Indices (I) Groups (J) Groups Mean Std. Sig. Difference (I-J) Error Total No. of Schizophrenia Mania -7.4333 1.519 .01 Responses Control -5.3667 1.519 .01 Mania Schizophrenia 7.4333 1.519 .01 Control 2.0667 1.519 n.s. Human Schizophrenia Mania 21.3667 4.981 .01 Responses Control 25.8667 4.981 .01 Mania Schizophrenia -21.3667 4.981 .01 Control 4.5000 4.981 n.s. Animal Schizophrenia Mania .2000 3.871 n.s. Responses Control -2.4333 3.871 n.s. Mania Schizophrenia -.2000 3.871 n.s. Control -2.6333 3.871 n.s. Anatomical Schizophrenia Mania -3.6000 4.732 n.s. Responses Control -11.7667 4.732 .05 Mania Schizophrenia 3.6000 4.732 n.s. Control -8.1667 4.732 n.s. Movement Schizophrenia Mania -1.5667 1.017 n.s. Responses Control -3.0000 1.017 .01 Mania Schizophrenia 1.5667 1.017 n.s. Control -1.4333 1.017 n.s. Most -Typical Schizophrenia Mania -4.1333 1.635 .05 Responses Control -2.5000 1.635 n.s. Mania Schizophrenia 4.1333 1.635 .05 Control 1.6333 1.635 n.s. Typical Schizophrenia Mania -10.6333 3.409 .01 Responses Control -29.2333 3.409 .01 Mania Schizophrenia 10.6333 3.409 .01 Control -18.6000 3.409 .01 Rejection of Schizophrenia Mania 13.5333 4.268 .01 Images Control 9.8667 4.268 n.s. Mania Schizophrenia -13.5333 4.268 .01 Control -3.6667 4.268 n.s. A systematic post hoc comparisons of various indices revealed that schizophrenics have lesser number of total responses than manic and normal subjects. However, there is no difference in total number of responses in manic and control groups. Human responses are significantly higher in schizophrenics. The animal responses on the SIS in Schizophrenic & Manic Patients 93

other hand failed to differentiate the groups. The SIS-I images have embedded somatic images and because of this, there is preponderance of anatomical responses in the protocols. The comparison of anatomical responses across the groups revealed that schizophrenics have given significantly lower anatomy content than the manic and control groups. The manic group did not differ from control group on anatomical responses. Similarly movement responses are lesser in schizophrenic group than the other two groups. No difference was found on movement responses in manic and control groups. Most typical indices were able to differentiate Manic and Schizophrenic groups. The Typical responses turned to be powerful indicators and could differentiate all the three groups. The Rejection of images was also turned to be a discriminator in schizophrenia and mania. The analysis of various indices across the groups reflected the discriminating power of SIS-I indices in clinical conditions. References: Banerjee,S. Mukhophadyay, A. and Singh, U. (1998). An In-Depth Study of Somatization in Heroin Addicts Through SIS-I and Rorschach Inkblot Test. SIS Journal of Projective Psychology and Mental Health. 6, 33-39. Cassell, W.A. and Dubey, B.L (1998) Application of Somatic Inkblot Series in Personality Assessment, Diagnosis Screening and Therapy. SIS Journal of Projective Psychology and Mental Health. 5, 3-32. Cassell, W.A. and Dubey, B.L (2003) Interpreting Inner World through Somatic Imagery, SIS Center, 4501E, 104th Avenue, Anchorage,AK-99516(USA) Kumar, S. Singh, R. and Mohanty, S.(2001) A Study of SIS-I in Hospitalized Male Chronic Schizophrenics. SIS Journal of Projective Psychology and Mental Health 8,31-34. Kumar, S. Mohanty, S. and Kumar, R. (2003) SIS Profile and its Correlation with Rorschach in Manic Patients. SIS Journal of Projective Psychology and Mental Health 10, 201-204. Mitra, G. and Mukhopadhayay, A. (2000) Psychological Factors in Drug Addicts and Normals : A Comparative Study. SIS Journal of Projective Psychology and Mental Health 7, 53-78. Mukhopadhyaya, A. Banerjee, S. and Mitra, G. (1996) A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS Journal of Projective Psychology and Mental Health 3, 33-41. Rathee, S.P., Goel, D.S. Saldanha. D.Chawla , M.L and Dubey. B.L (1994) Study of Somatic IInkblot Series in Coronary Cases. SIS Journal of Projective Psychology and Mental Health. 1, 51-64. 94 Kumar et al.

A Nervous System Based Model for SIS Inkblot Projection and Consultation Wilfred A. Cassell and Bankey L. Dubey An SIS consultant can provide rapid and comprehensive diagnostic/therapeutic consultation to clinicians in various parts of the world. Relatively immediate consultative aide is readily available through modern electronic communication technology (e.g. FAX , e-mail etc.). This article outlines certain underlying neural mechanisms underlying inkblot projection in SIS consultation. For illustration purposes, it assesses the SIS-II Booklet responses of a 47-year-old man in treatment at the University Psychosomatic Clinic in Ulm, Germany. The projective assessment was done “Blind” with no direct access to the overall clinical records. When done in this manner, the interpretations and management recommendations are essentially unbiased. This gives a measure of additional validity to the SIS consultant’s “second opinion”. The man was free of cardiac illness, yet was unduly concerned about his heart. In completing the brief health questionnaire on the last page of the Booklet, he indicated that his main concern was “heart trouble and pain.” In regard to the enquiry about mental problems in the questionnaire, he noted “depression and thoughts of suicide.” Certain unique diagnostic/treatment insights can be derived from a SIS consultation. It may be assumed that the clinician requesting projective test assessment has completed a detailed standard history. This should have provided preliminary evidence suggestive of one or more formal diagnostic categories. If the treatment employs traditional psychopharmacological intervention, then a plan involving medication has likely been established. However, in spite of detailed interviewing sometimes formal diagnostic issues and management issues remain questionable. Questions may exist such as the following: “Are there undetected psychotic symptoms that might warrant the addition of antipsychotic medication? Are there undetected Bipolar features? Are the somatic symptoms consistent with real physical illness or could they more likely to fit into some type of psychological pattern such as Conversion pain, psychophysiologic induced anxiety states, malingering etc.? Are there significant Axis II personality issues? Is there evidence of previously undetected organic disease?” and so on. If such questions have proved troublesome, a battery of standardized nonprojective psychological tests has often been completed. SIS projective assessment can supplement and enrich the above information complex in unique ways. In clinical settings, it provides a structured interview which opens both to the projective data gatherer and the suffering individual new avenues of in depth communication. Just like in hypnotherapy, it may provide access to memories that previously were blocked from full registration in consciousness. Wilfred A. Cassell, M.D.,APC,FAPA. President Somatic Inkblot Society, SIS Center, 4501 East, 104th Ave, Anchorage, AK 99516 Email:siscassell@yahoo.com & Bankey L. Dubey, Ph.D., DPM, Professor Panjab University, Director SIS Center India, Post Box 1107, Sector 15 Post Office, Chandigarh - 1600015 (India) E-mail : sisdubey@rediffmail.com Key Words: SIS Test, Projective testing, Inkblot imagery

96 Cassell & Dubey When assessing a particular SIS protocol, it is essential to keep in mind the source and nature of the complex and fluid imagery. SIS workers have developed a series of hypotheses to account for the manner in which mentally disturbed individuals respond to the inkblots. Yet we must be very careful in reading too much into the existing literature until more studies are completed and a firm body-mind-spirit theoretical framework is scientifically established. In terms of background theory for inkblot projection, several developments appear to have relevance. It has been repeatedly clinically observed that the SIS system can tap into memories that a traumatized individual cannot otherwise recall. This has been found to especially occur when the electronic forms are used. These have the advantage of utilizing the additional pulling power of the hypnotic flowers and sound tract, instructing the viewer to relax, in a trance-inducing manner. Relevant to this phenomenological observation is the work of Mark Solms consistent with the notion that many mental processes that determine cognition, body perception and emotional feelings can be “unconscious”. The behavior of patients who are unable to remember events that occurred after damage to certain memory-encoding structures of their brains appears to be influenced by the “forgotten” events. Cognitiveneuroscientists make sense of such clinical observations by delineating two memory systems that process information “explicitly” (consciously) and “implicitly” (unconsciously) In regard to the existence of “unconscious” memory systems that may underly emotional learning in 1996 at New York University, Ledoux demonstrated the existence under the “conscious” cortex a neuronal pathway that connects perceptual information with the primitive brain structures generating fear responses. Because this pathway bypasses the hippocampus - which generates conscious memories – current events routinely trigger “unconscious’ remembrances of emotionally important events, causing conscious feelings that may seem irrational. The literature in related fields relative to what Freud originally referred to as “repression” is also pertinent. SIS literature has noted a clinical correlation between failure to perceive anatomical images or ‘somatic repression” and a variety of sensory-motor problems (e.g. conversion pain and catatonia). A study of “anosognosic” patients by the behavioral scientist Ramachandran observed that damage to the right parietal lobe of these people’s brains makes them unaware of gross physical defects, such as paralysis of a limb. After artificially activating the right hemisphere of one such patient Ramachandran observed that she suddenly became aware that her left arm was paralyzed. This showed that she was capable of recognizing her deficits and she had unconsciously” registered the loss in her body gestalt, even though she remembered every other detail about the interview. Finally noteworthy is the relevant work with healthy normal subjects of neuropsychologist Martin A. Conway of Durham England. Overall such studies are of theoretical relevance to understanding the neural mechanisms underlying avoidance of embedded structure in the 62-item SIS series.

SIS Projection and Consultation in Cardiac Patient 97 Next mention will be made of work related to SIS response patterns, which are truly based upon projection, rather than the mechanism of visual perception. These may largely reflect imagery directly projected from either of the two memory systems postulated to exist in the brain. Such projected material can reflect directly or symbolically disguised in nighttime dreams. It also postulates that SIS stimulated imagery can represent spill over situations when dream material intrudes into day time consciousness such as in Dissociative Disorders and in psychotics, experiencing hallucinations and somatic delusions. Related work in the behavioral sciences suggests that dreaming and REM sleep are dissociable states, controlled by distinct, though interactive, mechanisms. Dreaming is generated by a network of structures centered on the instinctual –motivational circuitry of the forebrain. Solms and others have found that dreaming stops completely when certain fibers deep in the frontal lobe have been severed – a symptom, which generally coincides with a general reduction in motivational behavior. The lesion is exactly the same as the damage that was induced by prefrontal leucotomy that was once used to control hallucinations and delusions. This operation was replaced in the 1960s by drugs that dampen dopamine’s activity in the brain systems. Neuroscientists believe that this seeking system may be the primary generator of dreams. According to Solms, the new neurological data give rise to a trend suggesting that “psychological” conceptualizations of dreaming are becoming scientifically respectable again. He has noted that few neuroscientists still claim - as they once did with impunity – that dream content has no primary emotional mechanism. In an analogous fashion, it is proposed that the emotional charge and content of nonanatomical SIS responses could perhaps be based on the above-mentioned brain “seeking system”. For those anatomical responses which are judged by the SIS interpreter to represent projected body sensations, rather than cognitive familiarity, such as observed in certain medically related occupations, it is necessary to introduce a further construct in this brain based model of projection. An example of these would be heart responses in a subject experiencing stress triggered autonomic nervous system psycho physiologic cardiac arousal and associated “palpitations”. Sensory feedback of sensations derived from the augmented cardiovascular activity can provide additional input capable of influencing the above described central nervous system mechanisms further shaping the affect and content of SIS organ imagery. A final dimension in the proposed nervous system model involves taking into consideration sex differences that reflect varying hormonal influences on brain function. The effect of sex hormones on the organization of the central nervous system occur so early that external input from the SIS stimuli is acting on differently wired circuitry in boy and girls. Related to this is the tendency of males to experience more theme of aggression in their dreams and visualize these in SIS imagery. Females are more nurturing and likely to more readily imagine such scenes with SIS stimulation. The area of the brain that regulates reproductive behavior is the hypothalamus – a tiny structure at the base of the brain connected to the pituitary, the master endocrine organ. Parts of the interstitial nucleus of the hypothalamus are larger in men than women.

98 Cassell & Dubey Sexual orientation and gender have been related to anatomical variation in this region. In 1991, while at the Salk Institute for biologic studies in San Diego, Simon Levy reported that one of the interstitial areas that are usually larger in men than women is smaller in homosexuals than heterosexuals. Other researchers, Jiang-Ning Zhou of the Netherlands Institute for brain Research and his colleagues there and at the Free University in Amsterdam observed another part of the hypothalamus to be smaller in male-to-female transsexuals than in a male control group. These findings are consistent with the notion that sexual orientation and gender identity have a significant biological component. It remains a challenge for scientists to design follow-up studies to see how such sexual influences might shape SIS evoked imagery. ULM Case Consultation: In the evaluation of the projective protocols of mentally disturbed individuals, it is advisable to first examine the responses categorized as “Least liked”. This approach is most likely to lead to promising areas. It cues the examiner into what is most troublesome for discussion while stimulating memory recall for the individual experiencing emotional pain. The resultant detailed interview process more effectively empathetically bonds the human beings with psychological intimacy that goes beyond traditional formal professional interviews. Unlike ordinary social discourse, in reviewing SIS responses, the professional establishes - by these SIS interview conditions - empathetic permission to explore with the emotional support of a caring interviewer “irrational subjects” and express “confusing feelings” which may have been previously withheld. Examples include distorted imagery of hallucinations, PTSD flashbacks, anxiety-laden dreams, sexual concerns, paranoid perceptions, somatic delusions, suicidal/homicidal ideation and so on. With the SIS, the detailed enquiry is of utmost importance. It should be viewed as a starting point for structured communicating about issues, which are of high relevancy in the therapeutically releasing of the subjects “inner cry” SIS Responses: In the Ulm case study, the man selected Image B10 as the most threatening. Here he saw “Part of the body of a woman on the belly…these are disgusting abscesses.” Apart from the sexual implications of this response, this deterioration in anatomical imagery is suggestive of borderline psychotic features. If antidepressant medication is being used, it provides projective evidence for considering adding a low dose antipsychotic agent. Consistent with this, it points to the need for the interviewer to focus on questions related to possibility of somatic delusions involving body disintegration. Finally, it should raise questions in the interviewer’s mind regarding possible underlying aggressive impulses to a woman. This latter theme surfaces more clearly in subsequent SIS responses. The second most disliked one was B6. Here the theme of body image disintegration continued as follows: “The abdomen and legs of a man …the intestines are coming out of the abdomen…disgusting!” He emphasized in his written description the fact he didn’t like the images because they showed “destruction of human beings.” This pathological anatomical response further reflected disintegrating body imagery and depressive affect projected onto his body image as a psychological object in consciousness. This was consistent with his projection of negative feelings onto his heart and experiencing pain.

SIS Projection and Consultation in Cardiac Patient 99 The third least liked Image was B15. Here he visualized “A battlefield with tactical aircraft and rockets” and “An explosion.” This response includes considerable aggressive symbolism. . In view of the borderline psychotic features and strong aggressive energies, this projective response pattern was consistent with the SIS based recommendation to place him on suicidal watch until he was more mentally stable. It also appeared to be worthwhile to recommend active psychotherapeutic exploration of the source of his anger. Next an assessment will be given of his three favorite SIS Images. The image he liked most was A9. Here he visualized “A loving couple,” labeling the two central objects as hearts. This response shows that he had sufficient ability in abstract thinking to form human figure gestalts and symbolically introduce the emotional notion of “loving”. Given the psychotic concerns in his SIS protocol noted previously, this responses pattern was somewhat reassuring in terms of “ego strength” and positive prognosis. Next he selected SIS A7. Here he imagined seeing “A swinging person naked, a face with a mask, female genitalia.” The masked face reflected his anxiety in regard to sexuality. This provided further evidence concerning a need to further enquire into his sexual history. The third SIS Image selected in this category was A5 “A happy dancing person with a fine hat and a laughing face.” This suggested that prior to his depressive illness, that he may have been happy. It supported the prognostic prediction that with adequate treatment it likely would be possible to restore him to his premorbid state, which involved at higher level of mental functioning. The remaining clinical responses follow: A1 “It looks like the body of a giant with large arms.” Here it is apparent that the projective scene that emerged was threatening. “A giant” may reflect concerns about his anger’s intensity and control of aggressive impulses feelings. A2 was described as “Like a cyclone.” He labeled the upper right figure as “The head of a lion.” The cyclone symbolizes his aggressive impulses. A3 was seen as “Destructions in a bone, horrible,” “A theme of destruction inside the body…or a plane in fog”. This provided further evidence of his borderline [psychotic features as well as his subjective awareness of his mental impairments. A4 was perceived as “An abdomen with a colon”. This is an unusual anatomical response. It was projected in the relative absence of any reality somatic content in the SIS image. It suggests heightened somatic awareness of the gastrointestinal tract. It is consistent with the clinically observed tendency for depressed individuals to withdraw their attention from outer interpersonal relationships and focus it on internal organ imagery. Such internally focused patients frequently experience neuro vegative depressive symptoms involving abdominal distress involving impaired bowel function. A8 was seen as “A huge woman lying on the globe.” He saw the right arm-like aspect included in the SIS structure as “the body”. The area ordinarily seen as male urogenital content was stated to depict “female genitalia.” This atypical sexual association further indicated the need for the consultant to recommend a further review of his sexual history.

100 Cassell & Dubey A10 was seen as “The face of a woman very sad, makes me feel sad, too.” He labeled the left area “An injured eye,” and the right “A tear.” While this response pattern may refer to his depressive feelings, it also raised further questions in the consultant’s mind regarding his relationship with women. The injured eye is raised the possibility that he was hurt by a relationship with a woman and may have been physically abusive. Thus it seemed prudent to warn female care providers to be especially careful of arousing his anger in treatment situations. A11 Was said to “Looks like a sexual act with flowing movement.” This active erotic scene was projected in the total absence of any such embedded SIS structure. While it may have reflected frustrated sexual desires, although sexuality is highly variable, usually severely depressed middle aged diagnosed with Unipolar Depresion have reduced libido. Given the previously noted pressure of his anger, this raised the possibility that his underlying mental disorder may have features of Bipolar Disorder. Of course this is an important diagnostic distinction for the consultant to note. It may be recalled that while in the depressive phase of their illness such patients may require antidepressant medication; rarely this can estrogenically push them into a hypomanic phase. In any case, at all times they need the stabilizing psychopharmacologic effect of a mood-stabilizing drug. A13 was seen as “a hand in a ring of fire that reaches for help.” He added, “it is threatening.” Here the interviewer needs to be to enquire into the determinants of the response. It depicts his hand reaching for help - another positive prognostic indicator. A14 “looks like a cross on a cemetery.” The depressive theme of death and a cemetery emerged consistent with his depression and suicidal preoccupation. Alternatively it could signify a recent or past situation involving loss of a loved one. Clarification of this could facilitate therapeutically processing loss. A15 was seen as “A newborn child with a thick navel string,” This accurately recognizes the embedded SIS content and again provided evidence of his cognitive abilities. A16 was said to represent “Two kissing pigeons or lobes of the lungs with a heart between them.” The kissing scene is consistent with his projecting a love scene with 9A and continues an erotic theme . A 17 Here he saw “an open body and the heart laid open.” This symbolizes his psychological vulnerability and sense of broken hearted feelings. Loss of a love relationship may have triggered his depression. People saddened by loss of a loved one frequently experience cardiac discomfort (e.g., “My aching heart”). This may represent the perception of sensory changes secondary to the loss of internal positive psycho-physiological cardiovascular percepts ordinarily experienced within the body image during an intense love relationship. A18 was seen as “A flower bed in a park,” the central object was “A monument with an eagle.” This imagery lacks reference to the embedded cardiac content. It may be recalled that his chief somatic symptom involved “heart discomfort”. It is evident that moments earlier in viewing the previous SIS image emotionally painful heart symbolism forced itself into projective consciousness. In sharp contrast, here the mechanism of “repression” operated. It is proposed that this was mediated through the neural circuitry and “seeking system”. This illustrates the highly fluid temporal relationships involved in somatic inkblot projection.

SIS Projection and Consultation in Cardiac Patient 101 A19 was seen as “An abdomen with a colon”. This is an accurate recognition of the bowel structure embedded in A19. As such it does not represent the mechanism of projection. Rather it indicates an increased perceptual sensitivity to such material and his heightened awareness of the gastrointestinal system. A20 was seen as “Organs in the body, kidneys and bladder,” an unremarkable response. A21 “Looks like a bat or turtle,” another unremarkable response. A22 was seen as the “Male genitalia erected.” Here he allowed sexually aroused phallic imagery into full consciousness. While not in itself especially remarkable, it provides evidence related to differential diagnostic issues concerning possibly manically driven libido. A23 was seen as “A Japanese temple standing on the top and a spine of a snake.” Initially he totally repressed anatomical content and substituted non-threatening defensive material. When somatic imagery did rise in projective awareness as “the spine” it was symbolically disguised as the spinal column of a snake. A24 was “Four persons in a circle having a conversation.” This response avoided female pelvic content. It sharply contrasts with that previously noted with threatening material observed with B10. A25 was “Female genital wide open.” in itself this response is unremarkable, However, his envisioning the female genitalia as “wide open” again suggests that he may have been experiencing increase libido secondary to hypomania. A26 was seen as “A child with closed eyes just before birth” an unremarkable response. A27 was seen as “a very big, scratched bosom. What a pity!” He saw the upper area as “perhaps a broken coffin.” These responses have a high degree of psychopathology. With regard to the injured female breast, again this may reflect aggressive feelings toward women previously suggested in his response to SIS image to A10. His added comment, “what a pity”, suggests some degree of empathy and perhaps even guilt. The “broken coffin” repeats the death theme observed earlier. The recommendation for further interview exploration of this theme needs emphasis. A28 was stated to represent “A slender woman with flat bosom and raised arms… looks attractive.” This was a total projection. It provided a further projective clue of his increased libido. A29 was reported to remind him of “A dense mist with a roof in the background.” This response is consistent with A3 where he saw ‘A plane in a fog” symbolizing his awareness of cognitive impairment. A30 was seen as follows: “Looks like a death’s head with short cut hair. Creepy!” This continuation of death theme is consistent the need of placing him on suicidal observation status. A31 was seen as “Faces of a man and woman. She’s talking. He’s listening with pressed lips.” Advising the clinician to therapeutically explore this imagery could further lead to therapeutic avenues for exploring his relationship with possibly a specific woman.

102 Cassell & Dubey B1 was seen as “A burning forest.” This imagery again reflects his concern over controlling aggressive impulses. Questions need to be raised concerning possible fire lighting impulses. In 1979 Margaret Strickland using SIS-I found an increased number of fire responses in viewing SIS-I inkblots in Alaskan hospitalized psychiatric patients with histories of setting fires. B2 was “The ovary or the entrance of a cave.” The emphasis on female reproductive anatomy this response is quite abnormal and needs further exploration. B3 was seen as “A perforated dark ghost and two persons in a lighted room.” The “ghost” response is unusual for an adult man. It symbolically continues the death theme. B4 was stated to look like “Two heads of two men with deep lying eyes and beards.” Here the emphasis on eyes raised questions about possible paranoid concerns. B5 was imagined to represent “A man sending thoughts to the woman, the man on the left, the woman on the right, the thoughts being the central circular objects.” This is further evidence of the need to pursue therapeutic enquiry concerning a relationship with a woman. B7 looks like “The costume for a carnival hanging on a coat stand,” an unremarkable response. B8 was said to look like “Part of the face, a well formed nose,” another unremarkable response. B9 was seen as “Organs in a vessel”. Seeing the organs a vessel may be an association to some sort of autopsy specimen of a deceased person and again introduces the death theme. B11 was stated to be “Like the waistcoat,” and failed to associate with the embedded anatomical content. B12 was said to be “An egg with a chicken in development,” This was a most unusual and deviant response. It avoided reference to somewhat angry facial content inherent in his SIS Image. This repression is consistent with the notion that he was very threatened by his own aggressive impulses. B13 was said to represent “A faintly lightened part of a cathedral,” an unremarkable response. B14 was seen as “The tower of Pisa at night” Here projecting an image of a “leaning” build may symbolize his fear of loosing control. B16 was “the tail of a dragon, a fly, or a television tower standing on the top.” This response failed to recognize embedded spinal anatomy consistent with his avoidance tendencies of spinal imagery noted with SIS Image 23 A. B17 was stated to represent “An eclipse of the sun.” Here he avoided reference to the embedded cardiac content consistent with his conversion heart pain. B18 was “An eel in a water hose,” He added the comment “this is a classic phallic symbol enclosed in a wet sheath. This is consistent with concerns about sexual functioning noted previously. B19 was seen as follows: “Looks like a jellyfish catching two hearts.” This is a morbid pathological anatomical response. It symbolically may depict how he perceives disintegration and hence “pain” in his own heart. This further pointed to the need to explore more closely his relationships with women.

SIS Projection and Consultation in Cardiac Patient 103 B20 was seen as “The eruption of a volcano seen through a bull’s eye of a ship.” Volcanic eruption symbolizes agitation and turmoil. Here it is noteworthy that he avoids reference to the embedded structure depicting the brain. B21 was seen as “A just fired gun”. This response directly includes aggressive content. The consultation report needs to emphasize the need to actively enquire into both suicidal and homicidal impulses. B22 was “A man being in a spot of light, life escaping from him.” This response was consistent with his concerns about body disintegration and death. B23 was seen as “A big spider, the head is not seen.” This response sequence avoided the anatomical structure embedded in the image, ribs and chest cavity. It is central to his conversion pain that he avoids reference. B24 was seen as “Lift off of a rocket,” an unremarkable response. B25 was “An island in the sea with trees,” the lower central suggest area “The head of a woman” and up above “A lagoon.” The “woman’s head” emergence in projective consciousness again points to the need to therapeutically explore in detail his relationship with a woman both in real life, in his waking fantasy life and in his nighttime dreams. B26 was said to “Look like an ovary.” While this represents accurate identification of embedded anatomical imagery, it is unusual for a man to recognize this embedded anatomical structure. It reflects his preoccupation with female imagery first noted with his most disliked SIS Image. B27 was stated to look like “A fetus or twins,” an unremarkable response. B28 was stated to represent as “An old man in the open door with a bunch of flowers.” This response was highly abnormal and may have developmental significance. Most individuals see this image as mother and child. Failure to do so raises questions about the nature of his childhood relationship with his mother. It is possible that some of his preoccupation with female imagery relates to childhood lack of maternal nurturing. He may be searching for a mother figure and that this may have impaired his ability to relate in a mature way to adult women. B29 was seen as “A child running from the sun into the house through an open door.” Here the reference “A child” may suggest that he is somewhat fixated on unresolved childhood issues, as suggested with the former SIS Image. B30 was seen as “A brain or a land with two mountains.” This response is again atypical. Most people see two human ears. Instead he showed heightened projective awareness and anxiety with his brain function. Remarkably enough, this sharply contrasts with his “repressing” the brain content in SIS image 20B. B31 was seen as “A family with abnormal heads or four male genitals.” He then saw the heads as “mushrooms.” Most individuals see this as a loving family. It is included at the end of the test to elicit positive images and relax the subject for a calm, restful conclusion to testing. In this case, the subject had apparently serious problems with his family of origin. The “abnormal heads” symbolize his cognitive impairment. Projecting the response “male genitals” is consistent with heightened libido. It provides further projective clues suggestive of his suffering from one of the forms of Bipolar Disorder.

104 Cassell & Dubey Conclusion: The SIS has proved to be the most powerfull projective test for diagnostic and therapeutic intervention. The case demonstrated how SIS images helped in establishing " Blind" diagnosis in cardiac patient. Acknowledgements: The authors acknowledge the work of Dr Mark Solms who holds the chair in neuro psychology at the University of Cape Town in South Africa and the Royal London School of Medicine and Dentistry. He is also Director of the Arnold Pfeffer Center for Neuro-Psychoananlysis of the New York Psychoanalytic Institute, a consultant neuropsycholgist to the Anna Freud Center in London. He is also editor and translator of the forthcoming four-volume series "The Complete Neuroscientific Works of Sigmund Freud (Karnac Books)". Particularly relevant to the neural SIS projection mechanisms outlined in the above presentation is an overview article entitled Freud Returns which appeared recently in Scientific American (May 2004, pages 83-89. from the standpoint of scientific objectivity, the reader is also advised to review the follow-up criticism of Solm’s article by J.Allan Hobson’s entitled “ Freud Returns? Like a Bad Dream”. References: The Brain and the Inner World. Marc Solms and Oliver Turnbull. Other Press 2000. Cassell, W. A. and Dubey, B. L.(1997) Therapeutic Dream Stimulation with SIS- Video, J. Proj. Psy. & Mental Health, 4: 3-23. Cassell, W. A. and Dubey, B. L.(2003) Interpreting inner World through Somatic Imagery. SIS Center, Anchorage, Alaska(USA). Clinical Studies in Neuro-Psychoanalysis. K. Kaplan-Solms and M. Solms. Karnac Books 2000. Dreaming and REM Sleep are Controlled by Different Brain Mechanisms in Behavioral and Brain Sciences, Vol.23, No.6, pages 843-850; December 2000. Freudian Dream Theory Today, Psychologist, Vol. 13, No. 12, pages 618-619, December 2000. The Neuropsychology of Dreams, Lawrence Erlbaum Associates, 1997. Additional references for the theory of SIS projection can be found in the International Neuro-Psychoanalytic Society and the Journal Neuro-Psychoanalysis: www.neuro.psa.org. For different views and more information relevant is J. Allan Hobson’s work on the brain basis of the mind see his book Dreaming: An Introduction to the Science of Sleep (Oxford University Press, 20003). Lastly, the authors also acknowledge information obtained from a review article of Doreen Kimura: Sex Differences in the Brain, Scientific American, May 2004, pages 27-31.

Emotional Profile in the Context of Depression, Anxiety, Aggression & Adjustment of Epileptic & Non-Epileptic Adolescents: A Comparative Study Nilanjana Sanyal and Priyanka Banerjee This study was conducted on 40 epileptic adolescents (20 girls and 20 boys) and 40 normal controls matched on sex, age, religion, mother tongue and soico-economic status. The Raven’s Standard Progressive Matrices and the Bender Gestalt Test were used as screening devices. The Indian adaptation of Bell’s Adjustment Inventory, the Rosenzweig Picture Frustration Study, the Beck Depression Inventory and the State Trait Anxiety Inventory were administered to assess and compare the personality correlates of epileptic and normal adolescents. The results revealed that epileptic adolescents were significantly more depressed and anxious as compared to their normal counterparts irrespective of the sex of the individual. Epileptic adolescents were also seen to have more externalized aggression and lower toleration of frustration as compared to their normal counterparts. Family, health, emotional and social adjustment of epileptics is also significantly poorer than that of the normal adolescents. However, an interaction effect was noted with regard to social adjustment – epileptic girls were seen to have poorer social adjustment as compared to the epileptic boys, but normal girls were seen to have better social adjustment than the normal boys. With regard to emotional adjustment, it was noted that girls had significantly poorer emotional adjustment than the boys. In scientific parlance, the current era is called an era of inter-disciplinary approach. Psychology being a branch of behavioural sciences needs supplementary support from neurology, physiology etc. in order to unfurl the hidden sources of varied pathologies of mind. Hence, an important area of psychological study seems to be ‘epilepsy’. Epilepsy has been generating considerable interest and arousing curiosity, revulsion and sometimes fear the world over for eons of time. Epilepsy knows no barrier of nationality, caste, class, creed, race or sex. It affects not only the epileptic individual, but also his family members and all those who are close to him. Even a bystander watching an epileptic fit cannot help but get affected by it. Hales and Yudofsky (1987) defined epilepsy as “a condition of recurrent seizures due to CNS disease or dysfunction”, while they defined seizures as behavioural alterations of abrupt onset and termination that are associated with sudden electrical discharges of the brain”. There are many types of epilepsy. These may be broadly classified into four categories, namely generalized, partial, unilateral and unclassified epilepsies. Epilepsy does not refer to any specific disease but rather to a group of symptoms that have many different causes in different individuals. However, a number of external and internal factors are Nilanjana Sanyal Ph.D., Professor & Head and Priyanka Banerjee, Research Scholat, Dept. of Psychology, 92 APC Road, Calcutta University, Kolkata-700009. E-mail : ms_p_banerjee@hotmail.com Key Words: Emotional profile, Epileptic.

well established as predisposing to seizures, while certain factors operate to facilitate or precipitate attacks. These factors that facilitate seizures include both cognitive (Cirignotta et al 1980, Fenwick 1981, Fenwick and Brown 1989, Forster et al 1975) as well as emotive (Beck 1961, Barry et al 2001, Reynolds 1982, Betts 1981, Hauser and Hesdorffer 2001, Ettinger et al 2002, Currie et al 1971, Alwash et al 2002, Scicutella 2001, Blumer et al 1995, Falconer and Taylor 1970, Serafitinides 1965, Taylor 1969, Stevens and Hermann 1981, and Schachter , 2001) aggravating factors. Of all the developmental phases, adolescence is the phase, which is most, affected by emotional aggravations. Hence, the development of epilepsy during adolescence can lead to psychosocial difficulties over and above those normally associated with adolescence and can severely disrupt normal development. Thus, in the venture to locate the affective qualities of epileptic clients as being different from that of the non-epileptic ones, adolescents seem to be a relevant sample population. It is expected that even in the non-epileptic groups, emotional turmoil will be hinted at with regard to the selected variables. However, it is expected that the emotional profile of the epileptic adolescents will differ from that of their normal counterparts. Thus, in the present study, an attempt will be made to probe into this dissimilarity in the emotional profile. A significant amount of literature review has indicated that changes in affective qualities (such as anxiety, depression, aggression and adjustment) are related to brain dysfunction caused by epilepsy. The aim of the present study is to study the personality correlates of adolescent epileptic and normal individuals. The objectives of the present study would be to examine the difference between epileptic and normal adolescent boys and girls with regard to their (i) anxiety (ii) depression. (iii) aggression (iv) adjustment Method: Sample: A total number of 80 adolescents (epileptic N=40, non-epileptic N=40) were selected as the present sample. The criteria for their inclusion in the sample were their results on the screening tests– the Bender Gestalt test and the Raven’s Standard Progressive Matrices (an intelligence test). Epileptic subjects revealed neurological distortion, while their counterparts did not. In terms of intelligence, adolescents with average intelligence were included. The epileptic subjects who were included in the sample had previously been diagnosed as epileptics by the neurologists. There were both male (N=20) and female (N=20) subjects in both the groups. The age of the subjects ranged from 14-18 years. All the subjects were Hindus with Bengali as their mother tongue. They all belonged to the lower socio-economic strata. 106 Sanyal & Banerjee

The sources of the sample: Experimental Group-The S.S.K.M. Hospital, Department of Neurosurgery, O.P.D. Control Group-Bustee Welfare School and Ramesh Mitter Girls’ School Selected Tools: In the present study, data was collected by administering the following tests: Bender Gestalt Test - The Bender Visio-Motor Gestalt test is primarily used for predicting and diagnosing the brain damaged and normal subjects. It was developed by Bender (1937) based on the figures originally developed by Max Wertheimer for demonstrating the principles of Gestalt Psychology. Raven’s Standard Progressive Matrices- Ravens Standard Progressive Matrices was published by Raven in (1938). The test provides a means for comparing people with respect to their immediate capacities for observation and clear thinking. Beck Depression Inventory (BDI)- This scale was developed by Beck, Ward, Mendelson, Meckand Erbaugh(1961). It is a self report inventory which measures the severity of depression. However, it cannot be used to diagnose depression in the absence of a prior diagnosis, but can only measure the severity once the clinical diagnosis has been made. State Trait Anxiety Inventory (STAI)- The state trait anxiety inventory was developed by Spielberger, Gorusch and Luchene in order to study anxiety. It is a self-report inventory, which includes separate measures of state anxiety (i.e. a “transitory emotional condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity”) and trait anxiety (i.e. a “relatively stable individual differences in anxiety proneness…”) Rosenzweig Picture Frustration Study – ‘The Picture Association Study for Assessing Reactions to Frustration’ was developed by Rosenzweig. According to Rosenzweig (1945) this technique “stands midway in design between the word association and the thematic apperception techniques… the technique thus retains some of the objective advantages of the word association test while at the same time approaching to a degree the molar aspects of personality which the TAT is intended to probe” Bell’s Adjustment Inventory – The Adjustment Inventory was devised by Hugh M. Bell in (1935). Two forms of this inventory are available – one for adolescents and one for adults. Mohsin and Hussain (1981) adapted the Bell’s Adjustment Inventory (student form) in Hindi, which was later translated and standardised in English. Procedure: Selection of the Experimental Group: Data was collected from the OPD of the SSKM Hospital, Calcutta. The selected screening tests, the Bender Gestalt test and the Raven’s Standard Progressive Matrices Emotional Profile of Eplieptic Adolescents 107

tests were administered. Only those individuals who fulfilled the criteria of neurological dysfunction and average intelligence were selected. Selection of the Control Group: For this segment of the sample, the Bustee Welfare School and the Ramesh Mitter Girls’ School were approached and a similar procedure was implemented for screening the subjects. Only those individuals who were free from any neurological dysfunction and had average intelligence were selected. The selected sample group were administered the tests in the following sequence-– the Bell’s Adjustment Inventory, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Rosenzweig Picture Frustration Study. The tests were administered to each subject on two separate days. Treatment of the Data: The mean and standard deviation of the scores obtained by the epileptic and the normal subjects were calculated and t-test and ANOVA was used for comparison of the groups. Results: Epileptic Normal Adolescents Adolescents Mean S.D. Mean S.D. t-test Sig Depression Depression 25.54 12.22 9.67 5.11 7.57 Sig Anxiety State 51.93 11.44 44.22 9.24 3.31 Sig Trait 47.00 11.54 40.04 10.68 2.79 Sig Aggression Extragression 52.32 13.88 40.67 12.96 3.88 Sig Introgression 25.94 11.27 21.21 8.63 2.10 Sig Imagression 27.87 9.54 36.33 13.10 3.30 Sig Object Dominance 25.76 12.47 25.45 10.74 0.11 N S Ego Defensive 42.44 12.94 38.24 12.57 1.47 N S Need Persistence 29.94 9.84 34.44 12.14 1.82 N S Adjustment Home Adjustment 7.63 2.58 5.67 2.75 3.28 Sig Health Adjustment 7.47 2.7 5.47 1.47 4.11 Sig Social Adjustment 8.67 2.84 6.24 1.48 4.79 Sig Emotional Adjustment 11.44 2.84 8.9 2.48 4.20 Sig Table 1 Mean , Standard Deviation and t-test of Depression, Anxiety, Aggression and Adjustment Scores Obtained by the Epileptic and Normal Adolescents. 108 Sanyal & Banerjee

Epileptic Boys Normal Boys Mean S.D. Mean S.D. Depression Depression 25.87 10.94 9.93 4.53 Anxiety State 47.67 8.84 43.77 8.15 Trait 46.58 9.06 38.63 10.52 Aggression Extragression 55.33 17.17 42.07 13.68 Introgression 29.54 9.98 21.67 8.84 Imagression 24.37 10.54 39.6 14.58 Object Dominance 25.25 10.77 24.84 12.10 Ego Defensive 42.64 12.27 40.00 12.87 Need Persistence 27.78 9.97 31.24 12.16 Adjustment Home Adjustment 8.20 1.88 5.40 2.85 Health Adjustment 7.50 2.70 5.47 1.47 Social Adjustment 7.95 1.74 6.49 1.35 Emotional Adjustment 10.55 2.40 8.90 3.26 Epileptic Girls Normal Grils Mean S.D. Mean S.D. Depression Depression 27.20 13.12 9.30 6.45 Anxiety State 54.80 11.80 44.38 8.49 Trait 47.49 12.54 41.60 10.54 Aggression Extragression 47.27 12.98 37.49 13.95 Introgression 25.53 12.87 21.33 14.64 Imagression 30.99 9.88 38.90 12.41 Object Dominance 26.07 12.84 25.50 10.54 Ego Defensive 43.00 13.90 37.20 13.83 Need Persistence 32.00 9.72 37.74 12.16 Adjustment Home Adjustment 7.07 3.19 5.93 3.39 Health Adjustment 7.48 2.98 5.11 2.01 Social Adjustment 9.21 2.92 5.98 2.13 Emotional Adjustment 11.79 3.48 8.90 2.13 Table 2 Mean and Standard Deviation of Depression, Anxiety, Aggression and Adjustment Scores Obtained by the Epileptic and Normal Boys Table 3 Mean and Standard Daviation of Depression, Anxiety, Agression and Adjustment Scores Obtained by the Epileptic and Normal Girls Emotional Profile of Eplieptic Adolescents 109

Boys Girls Mean S.D. Mean S.D. t-test Sig Depression Depression 18.7 11.57 19.1 13.67 0.14 N.S. Anxiety State 46.17 8.47 47.87 11.88 0.73 N.S. Trait 45.52 10.24 45.21 12.17 0.12 N.S. Aggression Extragression 46.47 15.9 42.94 13.84 1.05 N.S. Introgression 25.9 10.11 23.22 13.28 1.01 N.S. Imagression 31.86 14.79 35.23 11.37 1.14 N.S. Object Dominance 26.21 11.11 26.17 11.57 0.01 N.S. Ego Defensive 45.84 13.74 39.99 13.99 1.88 N.S. Need Persistence 29.47 11.78 35.25 11.64 1.76 N.S. Adjustment Home Adjustment 6.47 2.61 6.83 3.05 0.56 N.S. Health Adjustment 6.75 1.84 6.41 3.1 0.59 N.S. Social Adjustment 7.22 1.79 7.85 3.24 1.07 N.S. Emotional Adjustment 9.58 2.76 10.25 3.11 1.42 N.S. Discussion: A detailed analysis of the statistical data reveals an almost theoretically expected emotional profile of epileptic and normal adolescents. The emotional profile of epileptic adolescents is seen to be distinctly different from that of their normal counterparts. The results of the present study are seen to be in harmony with the findings reported in the available literature (Beck 1961, Barry et al, 2001, Reynolds 1982, Betts 1981, Hauser and Hesdorffer 2001, Ettinger et al 2002, Currie et al 1971, Alwash et al 2002, Scicutella 2001, Blumer et al 1995, Falconer and Taylor 1970, Serafitinides 1965, Taylor 1969, Stevens and Hermann 1981 and Schachter 2001). The epileptic adolescents, due to their damaged brain functions, are seen to have a greater tendency towards depression, state and trait anxiety, aggression and maladjustment. The results indicate that the epileptic adolescents are significantly more depressed than their normal counterparts. Thus depression seems to be a common feature in epilepsy. These findings are corroborated by numerous research studies (Lambert and Robertson 1999; Barry et al 2001; Betts 1981; Currie et al 1971; Edeh and Toone 1987; Fiordelli et al 1993; and Ettinger et al 2002). Depression in epilepsy may be endogenous in character. The neurological deficit itself may be the cause of depression. The area of the brain affected may also influence the feelings of depression experienced by the adolescent. On the basis of their study, Lambert and Robertson (1999) concluded that depression was more common in patients with complex partial seizures especially of left temporal lobe foci. Table 4 Mean, Standard Daviation and t-test of Depression, Anxiety, Aggression and Adjustment Score Obtained by the Adolescent Boys and Girls 110 Sanyal & Banerjee

A number of psychosocial factors may be responsible for the depression displayed by the epileptic adolescents. The depression found in epileptic adolescents may be due to the lack of control in certain aspects of life. They seem to have less self-confidence, are uncertain about their performance and feel dependent on others due to the uncertain nature of their disorder. They may also feel helpless in the grip of their disease. Hence, they may feel more depressed. The parental anxiety and at times overprotective attitude and the feeling of being a burden on the family hinders the development of an identity of their own as being separate from that of the family. Restrictions on their movements and participation in the activities of choice as compared to their normal counterparts make them feel as if they are missing out on life. This may further add to their feelings of depression. The lack of knowledge regarding their disease and its prognosis makes them more vulnerable to depression. The reactions of revulsion or fear (due to the belief that they are possessed by evil spirits), their exclusion from the peer group due to their inability to move about freely and participate in their group activities and the fear of having a seizure in public may often lead to feelings of depression. Similarly, anxiety is seen to be a common feature in the epileptic adolescents. This anxiety may be due to feelings of being handicapped or disabled as they are prevented from participating in the normal activities of adolescence. The high state anxiety may be a product of the psychosocial environment, the most important being patient’s attitude towards the disease and the self image, family attitude and support, social class, employment, patient’s understanding of the condition and perception of how others view the condition.. The negative attitude of parents and the related feelings of helplessness may induce anxiety in the epileptic adolescent. The unpredictability of their attacks may also be a factor causing anxiety in the epileptic (Fenwick 1990). Epileptic Girls/ Interaction Normal Boys Effect F-ratio Remarks F-ratio Remarks F-ratio Remarks Depression Depression 43.25 Sig 0.04 N.S. 0.01 N.S. Anxiety State 8.96 Sig 3.77 N.S. 3.57 N.S. Trait 6.02 Sig 1.18 N.S. 0.17 N.S. Aggression Extragression 6.24 Sig 0.48 N.S. 0.001 N.S. Introgression 2.81 Sig 0.32 N.S. 0.05 N.S. Imagression 22.24 Sig 1.36 N.S. 1.84 N.S. Object Dominance 0.05 Sig 0.04 N.S. 0.001 N.S. Ego Defensive 1.45 Sig 1.34 N.S. 0.41 N.S. Need Persistence 3.76 Sig 3.02 N.S. 0.54 N.S. Adjustment Home Adjustment 8.47 Sig 0.48 N.S. 1.49 N.S. Health Adjustment 11.84 Sig 0.46 N.S. 0.8 N.S. Table 5 ANOVA of the Depression, Anxiety, Agression and Adjustment Score Obtained from Epileptic and Normal Boys and Girls Emotional Profile of Eplieptic Adolescents 111

Prevalence of high trait anxiety may be related to their inherent neurochemical or neurological disturbances. The study conducted by Alwash et al in (2002) revealed that anxiety symptoms were more likely to happen when seizures had not been properly controlled by medication. The epileptic adolescents have significantly more aggression than the normal subjects.. Thus epileptic individuals have more externalized aggression and lesser ability to tolerance or overcome frustrating situations. These findings are in line with the findings of Falconer and Taylor (1970) who found that aggression of an immature and explosive kind is often found in epileptic individuals. Epileptic adolescents tend to be overtly aggressive and impulsive. This may be due to the organic disturbances. On the other hand psychosocial factors may also have a role to play in the manifestation of their aggression. The difficulties they face in adjusting to their disease and to the social set up to which they belong drastically reduces their level of frustration tolerance. Their over dependent character pattern may also contribute to their lack of control over their emotions resulting in externalized aggression. They may also feel angry at the world at large due to their inability to satisfactorily adjust to it and also due to the many restrictions imposed on them by their epilepsy. Hence, they may exhibit greater externalized aggression. According to Serafitinides (1965) and Taylor (1969) aggression appears to be associated with early onset of seizures, male sex, low IQ, social class and a focus in the dominant temporal lobe. Lewis (1990) went a step further and said that central nervous system injury, cognitive impairment, episodic psychosis and a history of abuse are often associated with aggression in epilepsy. The epileptic adolescents are seen to have poorer all round adjustment. The overprotection they receive may lead to a lack of tolerance and greater dependence. This may make them emotionally non-accommodative in character. This attitude is reflected in their poorer adjustment in the home and social life in general. In the area of health adjustment it is automatically expected that they would have poorer adjustment than the normal counterparts who apparently seem to be free of physical complaints. The organic deficit present in the epileptic individual may also contribute to their emotional, social and family adjustment. Alwash et al (2002) also found significant adjustment difficulties in adolescents suffering from epilepsy . Results showed that age and sex matched control subjects had attained a higher educational level, had better living circumstances and were less dependent on their parents for their daily activities than the epileptic subjects. The findings also suggest that parental behavior toward epileptic children may delay psycho-social maturation. Thus, epilepsy does cause emotional, social, family and health maladjustment. The study brought to light a very interesting finding. It was seen that epileptic girls have poorer social adjustment than epileptic boys, but normal girls have better social adjustment than normal boys. It was also seen that girls have significantly poorer emotional adjustment than do boys. This finding may be the direct result of the socialization pattern prevalent in our country. The boys are pampered, while the girls 112 Sanyal & Banerjee

receive a lot less emotional and social support from their relatives. Girls are forced to abide by the social customs. The impulse based response patterns of epilepsy tend to cause a hindrance in adopting the dictums of society. Moreover, owing to the lower socio-economic standing of the present sample, girls were fond to be more neglected and considered to be nothing more than a burden. Conclusion: The present study has brought to our knowledge the bleak emotional profile of epileptic adolescents of the lower socio-economic strata in our country. People belonging to this class are restricted by their financial constraints. Epilepsy merely adds to their miseries. Adolescents are the future of our society. Epileptic adolescents form a large number of this population. Hence, we should not be blind to the problems they face, but should try to come out with medical or psychosocial supports to help them overcome these problems References: Alwash, R.H; Hussein, M.J; and Matloub, F.F (2002) Symptoms of Anxiety and Depression Among Adolescents with Seizures in Irbid, Northern Jordan, Seizure (Sept) Vol. 9 (6), 412-416. Barry, J.J.; Lenbke, A. and Huynh N. (2001) Studied Affective Disorders in Epilepsy Vol.88 21471 Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment Ettinger A.B. and Kanner, A.M (EDS) Lippincott, Williams and Wilkins, Philadelphia, pp 45-71. Beck, A.J., Ward, C.H.; Mendelson, M.; Mock, J., Erbaugh, J. (1961) Inventory for Measuring Depression. Arch. General Psychiatry 4, 516-571. Bell, H.M. (1934-1939) The Adjustment Inventory Palo Alto, Calif.: Consulting Psychologists Press. Bell, H.M. (1934) Manual for the Adjustment Inventory (Student form) Standard, California: Stanford University Press. Bender, L. (1938) A Visual-Motor Gestalt Test and its Clinical Use Research Monograph, American Othopsychiatric Association. Bender, L. (1948) Instructions for the Use of Visual Motor Gestalt Test. American Orthopsychiatric Association, New York. Betts, T.A. (1981) Depression, Anxiety and Epilepsy. In Epilepsy and Psychiatry, eds Reynolds, E.H. and Trimble, M.R. Churchill Livingstone: Edinburgh. Blumer, D.P. and Davis, K. (1995) Psychiatric Issues in Epilepsy Surgery Vol.88 21471 Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment Ettinger A.B. and Kanner, A.M (EDS) Lippincott, Williams and Wilkins, Philadelphia, pp 231-249. Cirignotta,F., Cicogna,P.,and Lugaresi,E. (1980) Epileptic Seizures During Card Games and Draughts. Epilepsia 21, 137-140. Currie, S., Heathfield, K.W.G., Henson, R.A. and Scott, D.F. (1971) Clinical Course and Prognosis of Temporal Lobe Epilepsy – a Survey of 666 Patients, Brain 92, 173-190. Edeh, J. and Toone, B. (1987) Relationship Between Interictal Psychopathology and the Type of Epilepsy. Results of a Survey in General Practice. British Journal of Psychiatry 151, 95-101. Eltinger, A.B. and Kanner, A.M. (2001) Psychiatric Issues in Epilepsy – A Practical Guide to Diagnosis and Treatment – Lippincott Williams and Wilkens, Philadelphia. Emotional Profile of Eplieptic Adolescents 113

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Role of Somatic Inkblot Series in Psycho Sexual Disorders in India: B.L. Dubey, Ajith, C., Somesh Gupta and Bhushan Kumar Somatic Inkblot series –II Booklet form was used to assess 30 cases of Psycho Sexual Disorder. SIS images proved to have pulling power to bring out the inner cry of suffering patients, which they were not interested in sharing with others. The PSD subjects have shown normal productivity, keeping contact with reality, preoccupation with sexual imagery and more concern with body imagery. Psychotherapy along with sex education and medical intervention helped the patient to lead normal lives again. Sex in India is often considered a word, which cannot be discussed publicly. Any open discussion about the subject is considered a taboo. Sexual relations are believed ideally to be restricted among married couples only and any sexual relation before or outside the marriage is thought to be a sin. This imparts a sense of guilt on the minds of both such partners. There is a constant fear of rejection by the society if some one is open about their sexual preferences or indulges in sex outside marriage. All this accounts for the large number of Psycho-Sexual Disorder (PSD) cases in the region. In PSD, the patient has an unshakable belief that something is wrong with his/her genitalia or sexual capabilities, though clinically they are normal both anatomically and functionally (Catalan, 1981). The belief arises from an underlying feeling of guilt over a previous sexual exposure, which was usually extra or pre marital. Many people believe that masturbation practiced over the years has weakened their sexual strengths. Such beliefs may arise from a source of misinformation related to sexual matters. Even psychological causes in the onset of certian psychosomatic disorders like impotence and asthma are well known (Dubey et al. 1977, Schatia, 1941). Psychotherapy forms an important part of management of these patients and may require multiple sessions to overcome their false beliefs and guilt feelings. Various methods, which help the expression of these inner feelings, form an important part of psychotherapy. Venereologists are often the first to be consulted by these patients and in most parts of the country there is a dearth of physicians properly trained to deal with such patients. Somatic Inkblot Series (SIS) is a structured projective diagnostic instrument and an adjustment to psychotherapy. SIS helps the therapist to peep into the inner world of the patient. SIS allows hearing the inner cry of the individual and brings out the unprocessed material from the unconscious (Cassell and Dubey, 1995,Dubey and Cassell, 1993). SIS provides a powerful technological-based imagery window for peeping into mysterious spiritual forces and helps us to deal with the crude and even vulgar aspects of the body gestalt. The present study is a modest attempt to find out the impact of PSD on the somatization Bankey L. Dubey, Ph.D., Professor of Human Behavior, University Business School, Panjab University, Chandigarh-160014 (India) E-mail:sisdubey@rediffmail.com, Ajith,C., M.D., Senior Resident; Somesh Gupta, M.D., Asstt Professor and Bhushan Kumar, M.D., Professor and Head, Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh-160012 Key Words: Psycho Sexul Disorder, SIS Test

of various body organs. Material and Method: Thirty subjects diagnosed as Psycho Sexual Disorder, in the age range of 24-56 years, attending the OPD of sexually transmitted diseases (STD) clinic of the Post graduate Institute of Medical Education and Research, Chandigarh were included in the study. It was a consecutive sampling. Except three cases all were educated above 10th standard. 22 were married and 8 were unmarried. After confirming the PSD diagnosis, they were administered Somatic Inkblot Series –II (Booklet form containing 62 images) individually by one of the authors (BLD) following standard procedure(Cassell, 1980) The SIS images were scored quantitatively for comparing the data with earlier studies on normal samples. Findings are shown in Table 1. Results: Table 1 SIS Responses of Psycho Sexual Disorder and Normal Subjects Indices PSD cases (n=30) Normal Subjects (n=100) (Cassell & Dubey, 2003) Total Number of Responses 63.03 74.08 Human Responses 20.63 14.66 Animal Responses 4.96 8.65 Sex Responses 8.96 4.12 Anatomical Responses 13.70 9.18 Movement 5.10 9.60 Most Typical Responses 14.30 13.68 Rejection of Images 2.03 0.82 Pathological Responses Present in 12 Almost nil Discussion: PSD is basically a disorder in which the patient is mentally disturbed about some aspect of their sexuality and hence presents with various somatic symptoms ranging from pain in genitalia to venerophobia. In majority of cases the symptoms are believed to be the result of some repressed guilt. Most cases of PSD arise after a sexual exposure, which is usually extra, or pre marital and may be unpleasant in some ways. Following this, the patient gets a sense of guilt or a sense of fear, which is believed to manifest as various somatic symptoms in these patients. Here we tried to correlate the extent of these inner feelings which is being manifested as symptoms in the patient. There are various psychological tools available for the expression of inner feelings of the subjects. Because of transparent nature of questions the available Questionnaires are not appropriate instruments. The SIS is a simple, interesting and effective tool, which may help the patients to express their inner cries. Thirty patients of PSD were subjected to the SIS test to find out the impact of PSD on somatization of various body organs. The SIS responses suggest that the subject has average productivity with functioning intellectual capacity and having contact with reality. He is concerned with other human being suggesting good interpersonal relationship. He is preoccupied with sexual 116 Dubey et al.

imagery, which might be due to his inability to have smooth sexual relations with his wife. More sexual responses may also indicate erotic satisfaction of viewing sexual imagery even on nonsexual images. Comparatively the PSD cases have given significantly more sexual responses (M=9.6) than the normal subjects (M=4.12)(Cassell and Dubey, 2003). Eight subjects have given more than 10 sex responses and three have given very high ranging from 24-38 sex responses. The sexual preoccupation in their minds compels the patient to see sexual percept at images, which in reality have no sexual projection. The high rate of sexual preoccupation in the patient’s mind clearly shows that the symptoms are related to his inner belief and therapy should be directed to reeducate the patient about such beliefs. Two subjects have rejected 11 images and 21 images respectively. This can be taken as very high rejection. The images they rejected were depicting interpersonal and erotic area. When a person is unable to perceive images in a concrete form, it can be taken as rejection. It has been noticed that people reject images, which depict certain precept related to their traumatized experience or underlying painful memory. For example, a person having poor interpersonal relationship may reject images 7A, 9A, 31A, 4B, 5B, 31B, because these images project human content. Poor interpersonal relationship with spouse may also lead to rejection of images 7A, 25A, 27A, & 18B. Images like 25A, 27A, & 18B project more of erotic content. Since this area is disturbed because of inability to have normal relationship, people may not feel like responding anything on these images. It has also been noticed that females traumatized sexually find it difficult to perceive image 22A, 23A, & 18B, which generally project spinal column and male genitalia. The symbolic meaning of these images may relate to male sex organs. Since these persons have undergone traumatizing experience and have unpleasant memories of the precept, they may find it difficult to see anything on these images. Even if they perceive something, often they give poor quality responses and attach a special meaning to it. Since these inkblots are highly structured - in the absence of any organic pathology- inability to perceive a particular blot can be highly clinically significant. It may help, in understanding his reactions to different situations presented through inkblot imagery. The avoidance of such images may further be probed to understand the unconscious process. Though responses to different images are quite relevant to understand the personality of the subject but the rejection of images may be equally relevant and may help in peeping through the inner self of the subject. Because of such relevance rejection of images have been given much importance while interpreting SIS protocol of a subject. The anatomical responses also showed a higher mean (M=13.70) and it is indicative of the patient’s awareness about his body. More anatomical response may also indicate anxiety, which might be a more plausible explanation in such patients. They have also given Pathological Anatomy of their body parts referring to genitalia. SIS analysis also helped us interpret a higher degree of aggression in some of the PSD patients. This was evidenced from the feelings of hostility and aggression expressed by a few patients. This clearly shows the importance of SIS in PSD. The SIS has helped to bring out the inner cry related to the symptomatology pertaining SIS in PSD Cases 117

to genitalia or abnormal sexual preoccupation in these cases. It would be most appropriate to include SIS test in the routine evaluation of PSD and other patients showing psychosomatic symptoms. Two case who have given more of sexual contents are discussed for better understanding of Somatic Inkblot images: Case 1: Fifty-six Years male, married, Graduate, having complaints of sexual dysfunction (lack of erection, difficulty in penetration) was administered SIS-II Booklet form of the test. He has shown preoccupation with sexual imagery and has seen sexual percept where normally no one perceives sex object. A few clinically significant responses on SIS images are given below: A 3: “Lady with one leg up” suggests his sexual preoccupation. Normally people reprove plant on this image. A 6: “Women’s two legs apart” again connotes the findings on A3. A 7: “Private part of a women”. A 8: “A woman is standing naked and a man is looking towards her”. A 11: “A man upon a woman doing sexual intercourse”. Responses on A7, A8 and A11 indicate sexual preoccupation. It could also be his wishful thinking of having normal sex relations, which he is not able to maintain. A 15: “A naked women with wild hairs”. A 16: “Private part of a women”. A 16: “A naked woman is standing and the private part is visible”. A 19: “Man and woman embracing each other” and the “Man is touching private part of the woman”. Such responses may indicate his desire to have normal relations with his wife, which he is not able to maintain, and getting the pleasure by sexual imagery. A 21: “A man / woman his cloths apart. A 26: “A woman is lying and other person is sitting over her”. A 27: “A woman naked by holding her clothes upward” may suggest his wishful thinking to have relations with female, which he is not able to have because of his problems. A 28: “Woman naked with visible bosoms” feeling of image A 27 is brought back on this image. A 29: “A woman lying naked” may indicate his wishful thinking of seeing the woman naked but unable to have relations with her. B 2: “Private part of woman” B 3: “A man and woman imaging Private Part of each other” indicate sexual pleasure at mental level through imagination than physical act. B 6:, B 7, B 9, B10 has been perceived as “Private part of woman” B 11: “Man and woman doing intercourse”. It may again indicate his wishful thinking of physical relations. B 12: “Private part of woman and a man is about to do intercourse” once apian the 118 Dubey et al.

feeling of A 27, A 28, A29 and B11is brought back. B 14:, B18, B 19 where perceived as "Private part of woman” B 16: “Private part of man” B 21: “A man’s organ about to enter a woman’s sex organ. It again indicates his wishful thinking to have pleasure through imaginations. B 24: “A penis in erection” suggests his own problems of not able to get erection. B 25: “Private Part of a woman” B 26: “Private part of man” Somatic Inkblot Images suggest high producing (R-81) contact with reality, having no psychiatric disturbances (MT-15), good inter personal relationship, controlled emotionality and aggression. He has given 38 sexual responses projecting his preoccupation such as lack of erection, unable to perform sexual act and feeling of impotence. Somatic Inkblot Images are able to bring out his feelings, which he finds difficult to share, with therapist. Psychotherapy along with sex education and medical intervention helped the patient to lead normal life again. Case 2: Forty-six years male, married, graduate with complaints of “pain after coitus and sore on the tip of the penis” was administered SIS-II Booklet test. He was worried about-his relationships with his wife because of invalidity to have satisfactory relationship. He perceived 24 sexual responses which is considered to be very high and a few are give below for better understanding of erotic projection: A 1: “Male sex organ”. It is unusual response on this image, as most of the people perceive two persons / animals on his image. A 3: “Male sex organ” Instead of seeing flower and plant he has seen male sex organ on this image. It is unusual response. A 4 “Female sex organ” Suggests his preoccupation wish sexual imagery of male female sex orgons. A 5: “Lady opening her legs” suggests sexual preoccupation. Normally a happy man, or laughing man is seen on this image but due to the problems he is unable to perceive happy man concept. This may also bring out the depressive feelings of the patient. A 6: “Male sex organ” suggests sexual preoccupation. A 8: “Female sex organ” suggests sexual preoccupation. A 1 0: “Lady’s eyes and face, weeping”. Seeing eyes and face is normal projection but weeping way connote his own feelings of seeing his wife depressed because of his inability to have normal husband-wife relationship. A 14: “Male sex organ” suggests sexual preoccupation. A 15: “Position of Intercourse” may again suggest his desire to have normal relationship. A 16: “Female sex organ-Intercourse taking place”. Normally people perceive two lovebirds or heart on this image. Avoiding of seeing “two lovebirds” may again indicate his disturbed relationship. A 18: “Female sex organ” his responses on A 15, A 16, A 17, A 18 also suggested his SIS in PSD Cases 119

preoccupation with sex particularly to perform normal sexual act which presently he is unable to have. A 28: “Naked Lady” suggests sexual preoccupation. Normally people perceive wrist/ hand on this image. B 1: “Some one is holding up a lady for love” indicate desire to have love relations. B 3:, B 7, B 8, B 9, perceived as “Male sex organ” B 12: “Doing Intercourse” B 13: “Male sex organ” B 16: “Male sex organ” Seeing repeatedly male sex organ on image B 3, B 7, B 8, B 9, B 12, B13 and B 16 suggest his sexual preoccupation and anxiety about his own sex organ. B 18: “Male sex organ” is a normal response on this image. B 21: “Male sex organ” is unusual response suggests sexual preoccupation. B 22: “Lady lying down”. Resting man/sleeping man is a common response on this image but seeing a lady lying down might indicate his frustration to see the lady in lying down position and his desire to avoid her. B 24: “Male sex organ” suggests sexual preoccupation. The SIS images once again brought on surface his deep-rooted problems to avoid sex and desire to lead a healthy normal life. The medical intervention with re-educative sex therapy helped the person to regain normal life. Other responses on SIS suggest his average periodicity, contact with reality, smooth interpersonal relations with different sets of people and controlled emotionality. Except sexual preoccupation he has not shown psychiatric disturbances. Somatic Inkblot images have also helped in therapeutic intervention. Reference: Catalan, J. (1981) Sexual Dysfunction and Psychiatric Morbidity in Patients Attending a Clinic for Sexually Transmitted Diseases. British Journal of Psychology, 138: 292-296. Cassell, W.A. (1980) Somatic Inkblot Series. Manual. SIS Center, Anchorage, Alaska(USA) Cassell, W.A. and Dubey, B.L. (1995) The Use of the Rorschach and Somatic Inkblot Series in Releasing Somatised Grief. SIS Journal of Projective Psychology and Mental Health, 3: 3-32. Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery. SIS Center, Anchorage, Alaska (USA) Dubey, B.L. and Cassell, W.A. (1993). Some Experiences with the Somatic Inkblot Series. British Journal of Projective Technique, 38,19-47. Dubey, B.L. and Singh, R. (1977) Personality Pattern of Impotence Cases Indian J. of Clinical Psychology, 4:95-101. Schatia, V. (1941) The incidence of Neurosis in Cases of Bronchial Asthma as Determined by The Rorschach Test with Psychiatric Examination. Psychosomatic Medicine, 3: 156-169. 120 Dubey et al.

SIS with Physically Disabled Adolescents. Dr. Ramjee Lal The present research makes an attempt to explore the differences in personality characteristics of physically disabled and normal adolescents with the help of Somatic Inkblot Series (SIS). SIS booklet was administered on a group of 25 physically disabled and 25 normal adolescents drawn from a Rehabilitation Center for Disabled at Jaunpur. The obtained protocols were scored on various response categories. Analysis of data revealed that disabled adolescents have poor interpersonal relationships show social isolation tendencies, are psychologically immature, have poor self- image, poor ego strength, show thought blockage and inability to think properly. The responses given by disabled on pathological scale reveal excessive concern about physical health, depressed emotional state, more hostility and aggression. They also experience exaggerated sense of self- consciousness in social situations. The diagnostic and clinical utility of Somatic Inkblot Series among psychiatric and non-psychiatric patients and normal subjects has been found very high in various studies (Rathee et al 1995; Dubey et al 1995). The findings of the studies on SIS-I published in SIS Journal of Projective Psychology and Mental Health from 1994- 2001 were meta analyzed by Srivastava ( 2002). Review of studies show that the SIS has been successfully applied on different groups. et al. (1994) conducted study on a group of 75 coronary cases and normal adults. A study on 2 male transsexual subjects was reported by Sahay and Srivastava (1994). In study with drug addicts Mukhopadhyay, Banerjee and Mishra performed personality comparison of brown sugar, heroin and tidigesic addicts. The personality profile of drug addicts on the basis of SIS responses has been prepared by a number of researchers ( Mitra and Mukhopadhyaya, 1996; Banerjee, Mukhopadhyaya and Singh,1998; Mitra and Mukhopadhyaya, 2000). SIS has been used in assessment of psychiatric disorders among various groups of psychotic and neurotic patients (Cassell & Dubey, 1988; Kumar Singh and Mohanthy, 2001;Manickam, Suhany and Jasseer,2004;Vimal, 2004; Kumar, Sharma, Mohanthy and Kumar, 2004). The review of researches reveals that no study has been carried out on physically disabled with SIS. The present study is an attempt to compare the personality profile of disabled and normal adolescents. Objective: A comparative study of personality characteristics of physically disabled and normal adolescents, with the help of SIS. Methodology: Sample: The present study has been conducted on a sample of 25 disabled adolescents taken from Viklang Punarwas Kendra, Jaunpur. 25 normal adolescents were selected for comparison. Ramjee Lal, Ph.D. Department of Applied Psychology, Purvanchal University, Jaunpur (U.P.). E-mail : drramjeelal@rediffmail.com Key Words: SIS in Disabled, Disabled Adolescents

122 Ramjee Lal Tool: Somatic Inkblot Series-II Booklet Form (Cassell 1980) was administered individually to all subjects. The Booklet consists 62 images presented in 8 pages. Instructions printed on the booklet were explaned and the subject was asked to writ the response on the record sheet. Analysis of Data: The total number of responses was counted for each subject. Number of Human responses, Animal responses, Anatomical responses, Sex responses, Movement responses, Most Typical response, Rejection of Images and Pathological responses were counted. To compare the personality characteristics of normal and disabled adolescents, significance of difference on each indices of the test was calculated by using t-test. The statistical analysis of data was done by calculating t-ratio. The descriptive statistics and t-ratio for both the groups have been presented in Table 1 Table 1 Mean, S.D. and t- ratio for Normal and Disabled group Indices Normal Group Disabled Group t-ratio p N= 25 N=25 M SD M SD Total Responses 87.36 12.07 85.84 8.56 .51 ns Human Responses 31.68 4.88 13.36 4.11 14.34 .01 Animal Responses 7.16 2.51 10.80 3.14 4.52 .01 Anatomy Responses 23.80 3.58 27.08 5.65 2.45 .05 Sex Responses 3.44 1.73 2.12 1.23 3.10 .01 Movement Responses .84 .89 .60 .70 1.05 ns Most Typical Responses 10.52 3.61 2.56 2.27 9.31 .01 Rejection of Images 4.12 2.55 11.2 3.58 8.04 .01 Pathological Response Anatomical Scale 1.40 1.60 4.00 2059 4.25 .01 Hostility 1.44 1.66 8.36 1.80 14.12 .01 Aggre ssion Scale Depression Scale 1.04 1.36 5.40 2.12 8.63 .01 Paranoia Scale .40 .57 1.88 1.05 6.16 .01 Results and Discussion: The results presented in Table 1 shows that marked differences have been found in personality characteristics of disabled and normal adolescents. There is no significance of difference in total number of responses (t =.51). It shows that normal and disabled adolescents have similar imaginative capacity and functioning intelligence. Normal Group has given more human responses ( M = 1.68, SD 4.88)as compared to disabled group (M = 13.36, SD 4.11). The obtained t value (14.34) is significant at .01 level of significance. It shows that normal subjects have good interpersonal relationship with human beings while disabled group shows a desire to be away from others and have tendencies of social isolation. Disabled group has given more animal responses (M= 10.80, SD 3.14) than normal group ( M= 7.16, SD 2.51). Significant difference has been found between both groups ( t = 4.52, p.01). It represents that the disabled

SIS with Physically Disabled Adolescents 123 adolescents feel more comfortable with animals than people. They exhibit more psychologically immature personality. Since disabled group has shown more anatomical responses ( M = 27.08, SD 5.65) than normal group (M= 23.80, SD 3.58) and a significant t value ( t = 2.45,p.05) shows that disabled have poor self- image than normal adolescents. The responses pertaining to sex signify sexual anxiety in normal adolescents than disabled. No significant difference has been found between both groups on movement responses. Normal group has shown more Most Typical Responses (M= 10.52, SD 3.61) as compared to disabled group (M= 2.56, SD 2.27), which are suggestive of coherent, logical thinking and ability to keep up with the demands of society. The disabled group has less ego strength and team concept than normal group. A significant t value 9.31 shows differences in the personality characteristics of disabled. Disabled adolescents have given more rejection of images than normal group that shows thought blockage and an inability to think properly. Normal and disabled group differs significantly on four pathological scales. The disabled adolescents have shown higher score on all pathological scales- Pathological anatomy Scale, Depression Scale, Hostility and Aggression Scale and Paranoia Scale. Conclusion: In sum, results have shown that disabled adolescents have poor interpersonal relationship, tendencies of social isolation, psychologically immature, poor self-image, poor ego strength and thought blockage. The responses given by disabled on pathological scale reveal excessive concern about physical health, depressed emotional state with more hostility and aggression. References: Cassell, W.A. and Dubey,B.L.(1998) Application of Somatic Inkblot Series in Personality Assessment, Screening, Diagnosis and Therapy. SIS J.Proj.Psy. & Mental Health, 5: 3-32. Dubey, B.L.,Cassell, W.A., Pershad, D. and Dwivedi, P.(1995) Diagnostic Utility of Somatic Ink blot Series. SIS J.Proj. Psy. Mental Health, 2: 77-84. Kumar,S., Sharma,V.D.,Mohanty,S.,and Kumar R.(2004) A Comparision of Human Figure Drwaing Among Schizophrenics, Manics, and Control Groups. SIS J.Proj. Psy. & Mental Health, 11: 47-51. Manickam,L.S.S., Suhany,B.T. and Jasseer,J. (2004) Psychotherapy of a Male Patient with Dissociative Convlsive Disorder : SIS- II Breaks the Resistance. SIS J.Proj. Psy. & Mental Health, 11: 36-44. Mitra,G. and Mukhopadhyay,A.(2000) Psychological Factors in Drug Addicts and Normals : A Comparative Study. SIS J.Proj. Psy. & Mental Health, 7: 53-78. Mukhopadhyay,A, Banerjee,S. and Mitra,G. (1996) A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS J.Proj. Psy. & Mental Health, 3: 33-41. Rathee, S.P., Goel, D.S. Chawla M.L.,Saldanha,D.(1994) A Study of Somatic Inkblot Series-I in Coronary Cases. SIS J.Proj. Psy.& Mental Health, 1: 51-64. Sahay,M. & Srivastava, P.K.(1994) Somatic Inkblot Series-II in Male Transexuals. SIS J.Proj. Psy. & Mental Health, 1: 73-78. Srivastava,A.K.(2002) Somatic Ink Blot Series-I : A Meta Analysis. SIS Journal of Projective Psychology & Mental Health, 9: 33-37.

Psychometric Evaluation of a Short Form of Holtzman Inkblot Technique C. R. Darolia and H. L. Joshi This study presents empirical evidence for the effectiveness of Herron’s short (30-inkblot) form of Holtzman Inkblot Technique. The data demonstrated fairly high internal consistency and temporal stability of most of the HIT variables. The internal consistency and temporal stability coefficient for most of the HIT indices were found to be larger than .60 and .70, respectively. Factor analysis of the 22 HIT variables yielded eight significant factors (eigen-values >1). The observed factor-structure replicated five of the Holtzman’s second-order factors with some minor variations. Overall, the findings suggest that short form of HIT has psychometric invariance with the standard 45-inkblot form of HIT as far as the factor structure of the two forms are concerned. However, in view of the fact that the 45-inkblot form of the HIT has not been used in the present study, further empirical evidences are needed to demonstrate the psychometric compatibility of the two forms of the HIT. The Holtzman Inkblot Technique (Holtzman, 1961) may be regarded as the natural successor of well-known Rorschach Inkblot Technique (Rorschach, 1921). Though the Holtzman Inkblot Technique (HIT) was constructed on the same lines established by the Rorschach, yet the new instrument claims psychometric excellence over its predecessor. By the end of World War II, the criticisms were increasing against the Rorschach (see Zubin, 1954). Holtzman along with his teammates tried to answer most of these criticisms, if not all, by developing a thoroughly new inkblot technique. The authors of this new instrument described their goal for developing “a new inkblot technique having scores of demonstrated psychometric value which still preserving the rich, qualitative essence of the Rorschach” (Holtzman, Thorpe, Swartz, and Herron, 1961). Now Holtzman Inkblot Technique (HIT) has emerged as one of the widely used inkblot technique in the area of personality assessment. From its inception in 1961 till the end of 1999, more than 800 publications using the HIT had appeared in the literature (Swartz et al., 1999) which speaks of its popularity among the researchers. These figures attest the prediction of Sundberg (1962) that HIT will become a hit (H-I-T). The HIT demonstrated several psychometric advantages over the Rorschach. First, the number of responses per individual could be held constant, i.e., one per inkblot. Second, convenient for quantitative treatment of inkblot responses. Third, new inkblot technique resulted in a richer variety of stimuli (a set of 45 inkblots), which can elicit more information than 10 Rorschach inkblots. Fourth, two parallel forms of the inkblots add to the reliability and other psychometric properties of the technique. The standard HIT consists of two parallel forms, A and B, each of which contains 45 inkblots. There are two additional practice inkblots (X and Y), which are identical in both forms. The selection of a blot in the two forms of the HIT (A and B) was based on three criteria: (a) its ability to discriminate between college students and hospitalized psychotic patients; (b) the amount that blot contributed to total scores on several variables; (c) inter and intra-scorer reliability. The two forms of HIT were constructed C.R. Darolia, Ph.D. Reader and Hardeep Lal Joshi Lecturer, Department of Psychology, Kurukshetra University, Kurukshetra-136 119 (India) E-mail: ishadi@rediffmail.com Phone: 91-1744 -238901(H) 91-1744-238410(Ext. 2521W), Key Words: Short Form Holtzman Inkblot Test, Evaluation of HIT

following the contemporary standards of test construction and psychometric equivalence was achieved by pairing blots on various stimulus qualities. The final order of presentation for the blots is arranged in a way that the “best“inkblots appear rather early in the series. Standardized administration and objective scoring procedure may be regarded as a distinctive feature of HIT. While developing scoring for 22 HIT variables, the Rorschach scoring system was carefully taken into account so that most of the relevant scores could be easily derived from the basic element in the protocols. Holtzman and associates (1961) considered four criteria in the formulation of the HIT scoring variables. First, the variable could be one, which is scored for any legitimate response with a score ranging from 0 to 45. Second, the variable has to be sufficiently objective to permit high scoring agreement among trained scorers. Third, the variable had to show a priori relevance to the study of personality through perception. And fourth, each variable had to be logically independent of others, whenever possible, in order to code the maximum amount of information. These criteria resulted into 22 objectively scored quantitative variables. The twenty two HIT variables are Reaction Time (RT), Rejection (R), Location (L), Space (S), Form Definiteness (FD), Form Appropriateness (FA), Colour (C), Shading (Sh), Movement (M), Pathognomic Verbalization (V), Integration (I), Human, (H) Animal (A), Anatomy (At), Sex (Sx), Abstract (Ab), Anxiety (Ax), Hostility (Hs), Barrier (Br), Penetration (Pn), Balance (B), and Popular (P). Although projective techniques are generally weak in reliability, HIT stands way out over other projective techniques with regard to reliability. The inter-scorer reliability coefficients for HIT variables ranged between .89 and .995 when highly trained scorers were employed and it ranged between .73 and .89 when examiners were having limited training. Split-half reliabilities have generally been found to be high, most estimates falling between .70 and .80 (Holtzman et al., 1961; Shukla, 1974). The test-retest reliability coefficient ranged from .39 (for P) to .82 (for L) over a period of one week. The range of these coefficients dropped down to .24 (for P) to. 75 (for L) when test-retest interval was increased to one-year (Holtzman et al., 1975). Unlike the Rorschach, the validity of HIT has been established using wide range of psychometric criteria. HIT variables have shown relationship with essential hypertension (Lucas, 1976), heart rate variability (Bowers & Keeling, 1971), REM deprivation (Feldstein, 1973), muscle tension and autonomic functioning during psychological stress (Shipman et al., 1970). Results of certain studies have indicated association between some of the specific behavioural measures and HIT variables (e.g., Chasey et al., 1974; Darby, 1970; Megargee and Cook, 1967). In view of wide applicability of HIT in academic, organizational, and clinical settings, the technique has been modified to suit these settings without sacrificing for its rich projective qualities and psychometric properties. Herron (1963) has recommended a thirty-item version (first thirty cards only) of the HIT, which can conveniently be administered during a regular college period of 45-50 minutes. Although the short version of HIT was developed for group administration, it has proved equally useful for individual administration. Swartz and Reinehr (1983) concluded that the use of quick version of HIT was indeed highly feasible and sufficiently promising to justify more extensive data collection. However, they recommended two responses per card instead of one for twenty five-card quick version. Though a few studies (e.g., Herron, 1963; Evaluation of Holtzman Inkblot Test 125

Holtzman, 1988; Swartz, 1992; Swartz and Reinehr, 1983) provide sufficient evidence for satisfactory reliability of the short/quick version, more systematic research attempt needs to be made before bringing it to real practice and research. The present study is one in this vein. Method: Sample: A sample of 231 subjects was drawn randomly from various post graduate departments of Kurukshetra University using the technique of cluster sampling. Since the test administrators in the present study were male, only male subjects were included in the sample. This was done in view of the fact that test administrator’s sex influences response pattern on projective tests and keeping tester and testee of the same gender will minimize such influences. The age of the selected subjects ranged from 20.5 to 27 years with a mean of 23.4 years. The sample covered a wide range of socioeconomic status and demographic settings. Test Material: The test material used in the present study comprised a short form of HIT (Herron, 1963) consisting of a set of thirty test inkblots and two trial inkblots. The major advantage of the short form is that it can be administered in a regular fifty minutes college period. Although most of the psychometric characteristics of the short form are yet to be established, Herron (1963) has reported satisfactory internal stability coefficients (around .70) for most of the HIT variables. Like the standard HIT, this form is also scored for all the 22 HIT variables. Administration and Scoring: The subjects were tested individually in a separate room suitable for peaceful administration. The short version of the HIT (only first thirty inkblots) was administered in accordance with standard procedure described in the HIT Guide (Holtzman, 1961). Elaborate instructions were given to the subjects to acquaint them with the task to perform. After establishing rapport, the inkblots were shown in an upright position to the subject, one at a time, in a prearranged order. The subject was encouraged to give only one response that first comes to his/her mind. The response followed a brief inquiry session to check certain aspects of the response and to obtain additional information helpful in scoring major variables. The inquiry session included questions such as “Where in the blot do you see a ….…?”, “What is there about the blot that makes it look like a ……?”, and “Is there anything else you care to tell about it?” The responses of the subject were recorded on a Record Form. Any change in the position of the card by the subject while responding was also recorded. The queries, if any, posed by the subject such as “Can I turn the card” or “Should I use the whole inkblot” were answered with a non-committal remark “that is entirely up to you”. The HIT protocols were scored for all the 22 variables. Six of the variables, viz., RT, R, L, FA, S, and Sh were scored at the time of administration itself. The RT, which is the time between presentation of a card and first scorable response by the subject, was recorded through an electronic stopwatch. Mean reaction time (in seconds) is taken as the RT score. Rejection is scored when the card is returned without any response. Rest of the sixteen variables was scored following the procedure outlined in Holtzman (1961). 126 Darolia & Joshi

Results and Discussion: Descriptive statistics along with reliability coefficients of 22 HIT variables are shown in Table 1. The observed patterns of mean scores and SD on various HIT indices are very much similar to that of the full form of the HIT reported in earlier studies (e.g., Holtzman et al., 1961; Joshi, 1998; Shukla, 1974). When compared with these earlier studies, it was found that the mean RT (pooled across all inkblots) on the short form (present observation) is almost equal to that of the full form (earlier studies). However, the means and standard deviations of remaining HIT variables are proportionately lower in the present study (on short form) as compared to the earlier studies (on full form). Scores on most of the HIT indices were found to be distributed normally as evident from observed coefficients of skewness and kurtosis (see Table -1). The few exceptions to this were the measures of Rejection, Pathognomic Verbalization, Anatomy, Sex, and Abstract which were found to be seriously skewed or peaked due to low and restricted scoring on these measures. Here it is important to mention that Table 1 Descriptive Statistics Sr. No. Variables Code Mean SD Sk Ku Rxx 1 Rxx 2 1. Reaction Time RT 22.82 7.21 .23 .51 .83 .89 2. Rejection R 0.09 0.28 3.18 1.53 .78 .81 3. Location L 30.24 5.79 -.29 .49 .71 .83 4. Space S 13.64 5.46 .26 .61 .41 .75 5. FormDefiniteness FD 61.62 7.42 .19 .39 .76 .73 6. Form FA 44.89 5.13 .30 .43 .72 .74 Appropriateness 7. Colour C 29.86 7.41 .23 .68 .70 .80 8. Shading Sh 26.92 8.12 .53 .31 .69 .76 9. Movement M 41.08 6.15 .27 .16 .71 .68 10. Pathognomic V 0.05 0.14 4.28 -1.28 - .47 Verbalization 11. Integration I 15.04 3.92 .68 .92 .64 .62 12. Human H 15.43 6.36 .16 .43 .73 .79 13. Animal A 19.87 5.87 -.24 .21 .62 .71 14. Anatomy At 4.15 2.96 .92 .47 .52 .61 15. Sex Sx 1.87 1.52 1.24 -2.36 - .59 16. Abstract Ab 14.82 7.71 .41 -1.08 .34 .55 17. Anxiety Ax 13.11 4.72 .25 .60 .53 .62 18. Hostility Hs 14.29 5.62 .28 .54 .58 .63 19. Barrier Br 24.13 3.16 .36 .12 .56 .67 20. Penetration Pn 11.08 3.18 .11 .26 .43 .59 Balance B 13.26 3.21 .23 .39 .49 .78 22. Popular P 5.87 2.39 .38 .73 .38 .56 Note : (i) SE Skewness = .16, SE Kurtosis = .319 (ii) Rxx1= Split-half reliability, Rxx2= Test-retest reliability Evaluation of Holtzman Inkblot Test 127

Table 2 Intercorrelation Matrix Variables RT R L S FD FA C Sh M V I H A At Sx Ab Ax Hs Br Pn B P RT .25 .32 .15 -.16 .19 .07 .23 -.15 -.16 -.25 -.21 -.07 -.02 -.04 .04 .02 .04 .05 .14 .20 -.10 R .06 .03 -.29 .10 .02 -.21 -.27 -.15 -.22 -.32 -.19 .06 -.07 .04 -.19 -.20 -.28 -.15 .05 -.14 L .21 .04 .39 -.35 -.17 -.26 -.21 -.46 -.13 .05 -.08 -.11 -.13 -.24 -.27 -.11 .31 .03 -.20 S .06 .16 -.12 -.05 -.10 .06 -.18 -.12 -.09 .04 .02 .04 .12 .13 -.09 .12 .11 -.05 FD -.11 -.33 -.29 .52 .19 .44 .59 .38 -.13 .06 -.11 .16 .29 .35 -.15 .08 .31 FA .04 .16 -.26 -.29 -.21 -.16 -.14 -.08 .02 .03 -.13 -.14 .05 .08 -.08 -.09 C .49 .03 .15 -.13 -.19 -.26 -.07 .14 .26 .32 .20 .16 .22 .08 -.11 Sh .06 .24 -.22 -.17 .09 -.07 -.11 .09 .19 .21 .31 .42 .19 .05 M .29 .51 .61 .20 -.14 .08 .14 .32 .51 .35 .17 .12 .32 V .04 .25 .26 -.10 .06 .15 .25 .39 .15 .23 .05 .20 I .41 .13 -.09 .02 .07 .15 .27 .30 .16 .13 .29 H .16 -.11 -.12 .05 .21 .29 .31 -.11 .05 .38 A -.19 -.16 -.20 -.06 .19 .26 .09 .11 .11 At .05 -.12 .03 -.06 -.21 .25 -.17 -.31 Sx .11 .09 .05 .02 .07 -.09 .09 Ab .44 .29 .10 .08 .03 -.11 Ax .66 .19 .19 .12 .08 Hs .22 .31 .25 .12 Br .22 .18 .26 Pn .09 .30 B .11 P N.B. r = .13 significant at .05 p level; r = .18 significant at .01 p level. 128 Darolia & Joshi

many of these indices (e.g., Rejection and Pathognomic Verbalization) are rarely observed in the protocols of normal healthy individuals and therefore they are likely to be distributed in a skewed way in samples of normal participants. Like standard HIT, its short form has also demonstrated very satisfactory immediate intra-subject (internal consistency) and delayed intra-subject stability. The split-half correlation (odd-even) corrected for full length (Gulliksen, 1950) was used as an index of internal consistency of the HIT indices. Split-half reliability estimates of all the 22 HIT variables (see Table 1) ranged between .34 and .83. It is pertinent to mention that internal consistency of projective measures is generally very low due to marked variation in responses elicited by different stimuli/items. But Holtzman’s (1961) strategy to include relatively large number of inkblots eliciting similar pattern of responses ensured satisfactory internal consistency of the HIT measures. Though the split-half reliability of some of the measures (e.g., Space, Abstract, Penetration, and Popular) is relatively low, in most cases the reliability is close to that reported for full form in earlier studies (Holtzman et al., 1961; Joshi, 1998). Low internal consistency estimates of these variables are understandable in view of the nature of these variables. Split-half reliability coefficients could not be estimated for Pathognomic Verbalization and Sex due to low frequency of such responses. Intra-subject stability over a period of time is generally regarded as more suitable measure of reliability for projective tests inasmuch as it taps a number of significant factors contributing to error variance such as motivation of the subject, temporary mood, and the response set induced by the examiner. Therefore, test-retest reliability was estimated by re-administering the HIT on 150 subjects after an interval of two months. Test-retest reliability coefficients, which are shown in last column of Table 1, ranged between .55 and .89 excluding Pathognomic Verbalization. It may be noted that delayed intra-subject stability (temporal stability) is relatively higher than immediate intra-subject stability (internal consistency). Comparison of these results with those reported by Holtzman (e.g., Holtzman, 1988 and Holtzman et al., 1961) for standard HIT reveals that the reliability coefficients observed for the short form in the present study are almost comparable to the standard form as reported in earlier studies. The question “How do HIT variables relate to each other?” also has a practical relevance. Holtzman et al. (1961) established that though the magnitude of correlation between any two variables is likely to vary from sample to sample, some of the variables have shown consistently substantial degree of correlation with each other. Perusal of the inter-correlation matrix (Table 2) reveals that correlations among various HIT variables range between -.46 and .66. However, around 29 % of these inter-correlations were near zero. No doubt, these bivariate correlations reveal meaningful information about communality among variables, but a precise picture of this overlap can best be revealed through factor analysis. Therefore, to reduce the observed correlations to a smaller number of factors the intercorrelation matrix was subjected to principal components analysis (Hotelling, 1933). The analysis extracted eight factors with Eigen values greater than 1.0 and accounting for 65.66 percent of the total variance. These factors were subsequently rotated to Kaiser’s (1958) varimax criterion of orthogonal rotation. The rotated component matrix appears in Table 3. Evaluation of Holtzman Inkblot Test 129

Examination of the rotated component matrix reveals that three HIT indices, viz., Form Definiteness, Human, Integration, and Movement loaded significantly on factor –I. Since prevalence of such responses reflects well developed and organized perceptual system, this factor may be interpreted as a factor of “Perceptual Maturity”. This factor is very similar to factor 1 of Holtzman and associates (1961) earlier work on standard HIT. Factor II in this analysis was interpreted as “Unconscious Anxiety” because it loaded significantly on such indices as Anxiety, Abstract, and Hostility. This factor resembles with Holtzman and associates factor 3 with an exception that Pathognomic Verbalization in the present analysis has a negligible loading. Shading, Colour, Penetration, and Barrier have significant and high loading on factor III. In the light of the earlier research findings that the projective measures of Shading and Colour reflect the potential for divergent thinking (e.g., Clark et al., 1965; Jalodia, 1995; Richter and Winter, 1966), this factor was labeled as “Creative Potential”. This factor is very similar to factor 2 of Holtzman and associates (1961). Table 3 Rotated Factor Matrix Sr. Variables Factors No. I II III IV V VI VII VIII h2 1. RT -.18 .09 .18 .33 -.21 .54 .01 -.10 .53 2. R -.41 -.03 -.35 -.06 -.14 .50 -.04 .06 .57 3. L -.08 -.24 .02 .80 -.18 .04 .01 -.11 .75 4. S -.08 .22 -.19 .60 .20 .15 .08 .15 .55 5. FD .77 -.02 -.18 .18 .15 -.07 -.12 -.01 .70 6. FA -.11 .03 .26 .48 -.54 -.10 -.20 .05 .64 7. C -.32 .45 .48 -.34 -.02 .03 -.08 .13 .68 8. Sh -.21 .14 .81 -.07 .16 .10 -.04 -.11 .77 9. M .68 .23 .11 -.17 .17 .05 .03 .09 .60 10. V .08 .19 .16 -.02 .78 -.10 -.09 .12 .70 11. I .69 .01 -.04 -.39 -.10 .13 .16 .14 .69 12. H .74 .09 -.08 -.07 .08 .-11 -.11 -.08 .61 13. A .32 -.32 .18 .12 .48 .01 -.14 -.33 .61 14. At -.13 .01 -.09 -.03 -.07 -.14 .87 -.08 .81 15. Sx -.04 .15 -.05 .02 -.02 -.20 .01 .74 .61 16. Ab -.01 .73 .02 .02 -.10 -.01 -.14 .06 .56 17. Ax .23 .74 .12 -.01 .17 .04 .13 .02 .67 18. Hs .37 .58 .17 .03 .36 .20 .14 -.02 .69 19. Br .49 .06 .53 -.03 -.09 .04 -.20 -.01 .58 20. Pn .08 -.01 .60 .25 .13 .20 .51 .31 .84 21. B .14 .06 .11 -.01 .11 .73 -.09 -.09 .59 22. P .42 -.26 .18 -.09 .18 .20 -.17 .56 .69 % Variance 14.52 9.29 9.19 8.07 7.25 6.01 5.84 5.49 65.66 130 Darolia & Joshi

Factor IV is a clear replication of Holtzman et al’s 4th factor. This factor is defined by Location, Space, and Form Appropriateness. In view of the nature of the variables bearing high loadings on this factor it may be named as “Good Form”. Factor V brings together Pathognomic Verbalization, Animal, and Form Appropriateness (reversed). But this factor may not be interpreted meaningfully in view of greater extent of error variance in one of the key markers of this factor. Holtzman et al’s (1961) factor 5 got replicated in the form of factor VI in the present analysis. High loadings of Barrier, Reaction Time, and Rejection on this factor indicate – the greater the score on Barrier, longer the Reaction Time and greater the number of rejected cards. Factor VII and VIII have less than three significant loadings. They appear to be residual factors which account the variance in measures that could not be explained by earlier factors. The foregoing description of the factor analytic findings, thus, suggest that though eight factors were identified as significant factors, only five of them were theoretically meaningful. Moreover, this five factor structure was very similar to the factor structure of the full form of the HIT reported in earlier studies (e.g., Holtzman, 1961). To sum up, findings of the present study suggest that the short form of the HIT (first 30 blots of the original HIT) is a satisfactorily reliable diagnostic tool and its psychometric properties are comparable with that of the original HIT (reported in earlier studies). However, the conclusion regarding the psychometric compatibility of the short and full form of the HIT must be taken with caution as it is based on comparison of two independent studies. Since, we have compared the psychometric properties of the short form of the HIT investigated in the present study with that of full form investigated in other studies (e.g., Holtzman et al., 1961; Joshi, 1998), it is likely that such comparison may not yield a true psychometric compatibility. Thus, it is suggested that to demonstrate the psychometric compatibility of the full and short form of the HIT in future, comparison of the psychometric properties of both the forms should be done by administering them on the same or comparable samples. References : Bowers, K.S., & Keeling, K.R. (1971). Heart-Rate Variability in Creative Functioning. Psychological Reports, 29(1), 160-162. Chasey, W.C., Swartz, J.D., & Chasey, C.G. (1974). Effect of Motor Development on Body Image Scores For Institutionalized Mentally Retarded Children. American Journal of Mental Deficiency, 78, 440-445. Clark, C.M., Veldman,D.J., & Thrope, J.S. (1965). Convergent and Divergent Thinking of Talented Adolescents. Journal of Educational Psychology,56,157-163. Darby, J.A. (1970). Alteration of Some Body Image Indexes in Schizophrenics. Journal of Consulting And Clinical Psychology, 35,116-121. Feldstein,S. (1973). REM Deprivation: The Effects of Inkblot Perception and Fantasy Processes. Dissertation Abstracts International, 33, 3934-3935. Gorham, D.R., Moseley, E.C., & Holtzman, W.H. (1968). Norms for the Computer Scored Holtzman Inkblot Technique. Perceptual & Motor Skills Monograph Supplement, 26, 1279-1305. Gulliksen, H. (1950). Theory of Mental Tests. New York: John Wiley. Herron, E.W. (1963). Psychometric Characteristics of a Thirty-Item Version of the Group Method of the Holtzman Inkblot Technique. Journal of Clinical Psychology, 19, 450-453. Evaluation of Holtzman Inkblot Test 131

Holtzman, W.H. (1961). Holtzman Inkblot Technique. New York: The Psychological Corporation. Holtzman, W.H. (1988). Beyond The Rorschach. Jr. of Personality Assessment, 52, 578-609. Holtzman, W.H., Diaz-Guerrero, R., & Swartz, J.D. (1975). Personality Development in Two-Cultures: A Cross-Cultural Longitudinal Study of School Children in Mexico and the United States. Austin: University of Texas Press. Holtzman, W.H., Thrope, J.S., Swartz, J.D., & Herron, E.W. (1961). Inkblot Perception and Personality: Holtzman Inkblot Technique. Austin: University of Texas Press. Hotelling, H. (1933). Analysis of a Complex of Statistical Variables into Principal Components. Journal of Educational Psychology, 41, 498-52. Jalodia, U.S. (1995). A Study of Relationship Between Types of Creativity and Types of Intelligence. Unpublished Doctoral Dissertation. Kurukshetra University, Kurukshetra. Joshi, H. L. (1998). Standardization of Holtzman Inkblot Technique on Indian High School Students. Unpublished Doctoral Dissertation. Kurukshetra University, Kurukshetra. Kaiser, H.F. (1958). The Varimax Criterion for Analytic Rotation in Factor Analysis. Educational Psychology, 23, 187-200. Lucas, J.D. (1976). A Study of Personality which Characterize Essential Hypertensives. Unpublished Doctoral Dissertation. George Washington University. Megargee, E.I. (1965). The Performance of Juvenile Delinquents on The Holtzman Inkblot Technique: a Normative Study. Journal of Projective Techniques and Personality Assessment, 29(4), 504-512. Megargee, E.I., & Cook, P.E. (1967). The Relation of TAT and Inkblot Aggressive Content Scales with each other and Criteria of Overt Aggressiveness in Juvenile Delinquents. Journal of Projective Techniques and Personality Assessment, 31, 48-60. Megargee, E.I., & Swartz, J.D. (1968). Extraversion, Neuroticism, and Scores on the Holtzman Inkblot Technique. Journal of Projective Techniques and Personality Assessment, 32, 262-265. Richter, R.H., & Winter, W.D. (1966). Holtzman Inkblot Correlates of Creative Potential. Journal of Projective Techniques and Personality Assessment, 30, 62-67. Rorschach, H. (1921). Psychodiagnostics (Hans Huber Verlag, Trans.) Bern: Bircher. Shipman, W.G., Oken, D., & Heath, H.A. (1970). Muscle Tension and Effort at Self-Control During Anxiety. Archives of General Psychiatry, 23, 359-368. Shukla, T.R. (1974). Split-Half Reliabilities of HIT Variables. Indian Journal of Clinical Psychology, 1(2), 101-103. Sundberg, N.D. (1962). The Rorschach Americanized. Contemporary Psychology, 7, 250-252. Swartz, J.D. (1992). The HIT and the HIT 25: Comments and Clarifications. Journal of Personality Assessment, 58, 432-433. Swartz, J.D., & Reinehr, R.C. (1983). A Quick Version of Administration for the Group Holtzman Inkblot Technique. Perceptual and Motor Skills, 56, 513-516. Swartz, J.D., Reinehr, R.C., & Holtzman, W. H. (1999). Holtzman Inkblot Technique, 1956-1998: An Annotated Bibliography. Austin: University Of Texas Press. Zubin, J. (1954). Failures of the Rorschach Technique. Journal of Projective Techniques, 18, 303-315. 132 Darolia & Joshi

Second Announcement Invitation 5th International Conference of Somatic Inkblot Society, Kochi (Kerala, India) on November 26-28, 2004. Dear Sir, The Chairman and the members of the Organizing Committee have great pleasure in inviting you to the 5th International Conference of Somatic Inkblot Society to be held at Hotel Circle Manor, Kaloor, Cochin, Kerala (India) from November 26-28, 2004. This is a Joint Venture of Dhanya Nursing Home, Palarivattom, Kochi - 682 024 and Somatic Inkblot Society. The SIS is an international, non-profit scientific organization with its main office in Anchorage, Alaska (USA). We are devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. Dedicated to the use of projective technique in the healing arts, one of our primary goals is the promotion of teaching, research and practice of the SIS test, a projective assessment tool. The November 2004 conference is a reflection of our aim to reach clinical psychologists, psychotherapists, social workers, medical professionals and business executive interested in the understanding and modification of human behavior. The conference brochure is attached and contains more detailed information. We welcome your questions and inquiries for additional details. The purpose of the conference is to provide a forum, where members of Somatic Inkblot Society, Psychologists and Medical Professionals interested in studying human behavior, can present their scientific work. It will further help to share their experiences relating to the applications of psychology. The convention programs include presentations of scientific papers, invited addresses, discussions and workshops on the application of various forms of Somatic Inkblot Technique. We hope you will accept our sincere invitation to attend this conference. Indians are known for their hospitality and we are sure you will enjoy your visit to India. With warm regards, Dr. Prakash Chandran Prof. B L Dubey, Ph.D. Chairman Org. Committee Vice President, Somatic Inkblot Society 5th SIS International Conference, P.O.Box: 1107, Sector-15 Post Office, Dhanya Nursing Home, M.K.K.Nair Road, Chandigarh-160015(India) Edappally.P.O., Palarivttom, Email: sisdubey@rediffmail.com Kochi - 682 024 (Kerala India) Mobile: 91-94170-36655 Email: prakasharackal@rediffmail.com Tel: 91-172-2710986 Mobile: 91-98470 39971 Tel: 91-484-2536709 SIS Conference 133

Theme of the Conference: Personality Assessment, Stress Management and Aging. Sub Themes: Projective Psychology, Mental Health Psycho Neurology, Educational problems Therapeutic Intervention Call for Papers: Those who wish to present papers in the coming conference, send the Abstract of their papers/Workshop on or before September 15, 2004. Abstracts should be typed in double space, consisting approximately 200 words, stating the objectives, methodology, results and conclusion, along with name, mailing address and e-mail of the authors. The scientific committee will select the suitable papers for presentation. Young scientist award will be given to the best paper presented by a young research scholar. The SIS Society will also present two SIS best paper research award for the papers on the application of Somatic Inkblot Technique. Submit the Abstract to: Dr.Prakash Chandran, Chairman, 5th SIS International Conference, Dhanya Nursing home, M.K.K.Nair Road, Edappally.P.O., Palarivttom, Kochi - 682 024 (Kerala, India) Email: prakasharackal@rediffmail.com Tel: 91-484-2536709, Mobile: 91-98470 39971 For SIS Research Award Submit Full Paper to: Bankey L.Dubey, Ph.D., Director SIS Center, P.O. Box 1107, Sector-15 Post Office, Chandigarh-160015 (India) Email: sisdubey@rediffmail.com For more information about confrence contact the following numbers: Dr.Prakash Chandran Mobile: 91-98470 39971, Tel: 91-484-2536709 Dr. M Mohandas Mobile: 91-98472 39916 Dr. Ajith Kumar Mobile: 91-94470 66870 Mr. Padma Kumar Mobile: 91-98471 30688 Mrs. Srija Bose Mobile: 91-94471 62495 134 SIS Conference

The above-mentioned registration fee includes food and accommodation on twin sharing basis. The convention badge with name printed will be given to those who communicate their participation before October 15th 2004. Please register your name at the earliest to provide you the maximum comfort during conference. For registration, send DD favoring Chairman, SIS Conference, payable at Ernakulam at the following address: Dr.Prakash Chandran, Cofernce Chairman, Dhanya Nursing home, M.K.K.Nair Road, Edappally.P.O., Palarivttom, Kochi - 682 024 (Kerala, India) Conference Venue: Conference will be conducted in Hotel Circle Manor, Kaloor, Cochin, Kerala (India). Kochi, known as the ‘Queen of the Arabian Sea’, is located in the middle of Kerala State. Kerala is well known as ‘God’s own country’. Kochi is about 125 Miles from Trivandrum, (Capital of Kerala) and also from Coimbatore (Tamilnadu). Conference center is 14 Miles away from Kochi International Airport and 3 Miles from Ernakulam town Railway Station. Explore the attractions of Kochi as well as the beauty of Kerala such as beaches, cultural centers, temples, Historic synagogue, paintings, backwater travel etc. Climate in Kochi in November is very cozy with medium hot and cold. You do not require woolen clothing. You can enjoy the spirit of the land while you are here. KOCHI WELCOMES YOU SIS Conference 135 Registration Fee: The convention registration will begin from July 15, 2004. Registration is required to support the process of the conference. The registration fees for the conference are as follows: Until Sept. 30.2004 Fee Indian Delegates : SIS Members: Rs.1400/-. Non-SIS Members: Rs.1500/- Students: Rs.1200/-. Spouse: Rs.1000/ Children 10-15 yrs: Rs. 800/- Foreign Delegates: US $ 100. After Sept. 30.2004 Fee Indian Delegates: SIS Members: Rs.1600/-. Non-SIS Members: Rs.1700/- Students: Rs.1200/-. Spouse: Rs.1000/ Children 10-15 yrs: Rs. 800/- Foreign Delegates: US $ 100.

Book Review Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot Series By Wilfred A. Cassell and B.L. Dubey; Somatic Inkblot Center, 4501 E, 104th Ave, Anchorage, AK 99516 (USA) Pages 164. Applications of somatic imagery have had far-reaching effects at the international level. A data bank is being developed where individuals from various Somatic Inkblot Series (SIS) Centers around the world may submit data and access information via modem of facsimile communications. The SIS has been found successful in assessing certain important areas like interpersonal relationship, ego/self image, healthy body imagery, thinking in group conformity, erotic imagery, hostility/aggression and insecurity, say the authors of this book. The SIS is a new projective technique for the assessment of personality and psychopathology. The authors have comprehensively described the historical development of the inkblot procedures and provided information regarding its administration, scoring and interpretation. The book is the study of the human personality aspect and emphasizes on various traits of normal individuals, clinical groups and successful executives. The book has been divided into seven chapters and in the end, 11 case studies have been given for the readers to correlate the psychological problems which human being faces in everyday life. In the introductory chapter, the authors have explained in detail the meaning of Somatic Inkblot Series and given its historical background. The SIS provides those having psychological disorders “with diagnostic and therapeutic aid. A series of inkblot images are shown to the individuals, who then write responses on a record sheet. The meaning of these images are interpreted and shared with the viewer. The authors have proved that the applications of the SIS procedure have had far reaching effects in personality development. In chapter 2, the authors have given the historical development of the SIS technique. The inkblot techniques have been used earlier, however, these became popular only through the writings of Rorschach in 1921, who traced the concept of formless stimuli used in the inkblot techniques by Leonardo da Vinci and Botticelli in the 15th century. Chapter 3, conceptualizes the SIS procedures through a Booklet of images and Video of SIS-II images. The authors say that the SIS may be used as a guide to develop personalized visual imagery for meditation and enhanced spiritual awareness. They have explained the relationship of body imagery and illness and suggested the therapeutic intervention through somatic imagery. In chapter 4, 5 and 6, the authors have portrayed beautifully the psychometric properties based on reliability and validity of responses. The procedures for administration and

138 Vasudeva instructions for conducting the SIS-based tests have been explained in a simple language. The chapter 7 gives the interpretations and applications of the SIS responses including the guideline for interpreting. The book is full of clinical wisdom and will be of great values for psychiatrists, psychologists, therapist and those who are interested in understanding human behavior and it’s modification. Dr. Uma Vasudeva Medical Officer, Incharge Leprosy Eradication Project, Govt. of India, # 59, Sector 8, Panchkula, Haryana (India) E-mail : vasu022@rediffmail.com

THE SOMATIC INKBLOT SOCIETY I wish to be a Member __________ a Life Member ________ of the Somatic Inkblot Society. Please submit this request to the Membership Committee. NAME ____________________________________ Birth date _____________________ (Print or type) First Middle Last ________________________________________________ Zip ____________________ Business/Office Address : _________________________________________________ ______________________________________________Tel. : (W)__________________ ___________________________________________________(H)_________________ EDUCATION Degree Year Institution Major Field of Study EMPLOYMENT : Current position, employer, dates (Graduate Students indicate area of study and degree toward which you are working). MEMBERSHIP : __________________________________________________________ TRAINING AND EXPERIENCE IN PERSONALITY ASSESSMENT : SPONSOR (S) Name Address Telephone 1. _____________________________________________________________________ 2. _____________________________________________________________________ SIS subscription payable every year in January through Cashier Cheque/Draft I certify that the information provided above is accurate and correct. An APPLICATION FEE Cheque is enclosed for Foreign Members ($40) & Life Membership ($300).For Members in India Rs. 250/- & Life Membership Rs. 2000/- Total Cheque $/Rs._______________Drawn at_________________________________ Signature of applicant : _______________________________ Date :________________ PLEASE RETURN with your cheque to : B.L. Dubey, Ph.D., Vice-President, Post Box No. 1107, Sector 15 Post Office, Chandigarh – 160 015 (India). Tele/Fax : 91-172-2710986, Mob.: 91-9417036655 E-mail : sisdubey@rediffmail.com Web Site : http://www.somaticinkblots.com Make cheques payable to Somatic Inkblot Society, Chandigarh (India) N.B. : Please add Rs. 50/-/($5) as one time registration fee; and Rs. 70 ($5 forgin Member) if you are sending subscription through out station cheque.

Professional Quality VHS Videotapes (specify NTSC, PAL or SECAM), as well as Audio Tapes and Transcripts of Interviews are Available for Teaching/Clinical Purpose. Police case--"Witnessing an Accident" Vietnam Veteran -- "Unresolved Guilt" Therapeutic Dream Stimulation Anniversary Reaction to Miscarriage Grieving a Still Birth : Conversion Reaction Fear of Cancer and Hypochondriasis (includes Rorschach imagery) Alcohol and Cocaine Depended : Father/Son Incest : Tee-age Alaska Native's Death by Gas Inhalation Suicide Behaviour in Adolescent Alaska Native Nightmare Vision (Sexually Abused Adolescent Girl and Absence of Father Figures in Black Adolescent Boy) Auschwitz Revisited Neuropsychological Reactions to Life Threatening Accident & SIS Occupational Stress and the SIS The use of the SIS as an Aide in Meditation while Grieving a Miscarriage SIS-Video (A&B Series), SIS-I Videotape, SIS-Living Images A Walk Through The Garden of Life and many more, Audio & Videotapes SIS Journal of Projective Psychology & Mental Health in C D (Acrobat and Page Maker) from Volume 1-11 Contact : SIS Center, 4501 E, 104th Ave, Anchorage, Alaska-99516 (USA) E-mail : siscassell@yahoo.com OR sisdubey@rediffmail.com Web Site : http://www.somaticinkblots.com for getting the above material

STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : T-2/15, Sector-25 Chandigarh - 160014 PERIODICITY OF PUBLICATION : Half Yearly EDITOR'S PRINTER'S Name : Dr. B.L. Dubey PUBLISHER'S NATIONALITY : Indian ADDRESS : T-2/15, Sector 25, Chandigarh - 160015 OWNER : SOMATIC INKBLOT SOCIETY I, Dr. B.L. Dubey, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. B.L. Dubey, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Printed and Published by Dr. B.L. Dubey on behalf of Somatic Inkblot Society from T-2/15, Sector 25, Chandigarh - 160014 & Printed at Juneja Trading Agencies Pvt. Ltd. Printing Press, SCO 131-132, Sector 17-C, Chandigarh. Tel. : 2702675, 2704715. Editor : Dr. B.L. Dubey

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITOR-IN-CHIEF : B.L. Dubey, Ph.D., Director SIS Center India, Post Box 1107, Sector 15 Post Office, Chandigarh-160 015 Tel/fax : 91-172-2710986, E-mail: sisdubey@rediffmail.com EDITORS : Anil Agrawal, BE, MBA, C.E.O,Telephone Cables Ltd., 68-70, Sector 17-C,Chandigarh E-mail : aagarwal33@yahoo.com : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Ave. Anchorage, AK 99516 (USA). E-Mail: siscassell@yahoo.com : Anand Dubey,B.E., MBA, SIS Center, 4240 Edinburgh Drive, Anchorage, AK 99515 (USA) E-Mail: adubey@hotmail.com : Padma Dwivedi, M.A., Social Worker, Dept. of Cardiology, Post Grad. Medical Institute, Chandigarh Tel.: 91-172-2710986 : Rakesh Pandey, Ph.D. Reader, Dept. of Psychology, M.G. Kashi Vidya Peeth, Varanasi-221001. Tel.: 91-542-2318246 E-mail : rpan_in@yahoo.com : Amool Ranjan Singh, Ph.D. Professor, Dept. of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry & Applied Sciences, Kanke, Ranchi - 834006. Tel.: 91-651-2233687 E-mail :dr_amoll_r_singh@rediffmail.com JOINT EDITORS : L. S. S. Manickam, Director, CAPS, Thirupuram, Thiruvananthapuram 695133 (India), Email: sammanickam@satyam.net.in : Tamera Randolph, PO Box 244045, Anchorage, AK 99524 (USA) E-mail: tamerarandolph@hotmail.com Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi Phillip W. Baker, Ed.D., U.S.A. Mahesh Bhargava, Ph.D., India D.K. Bhatt, B.E., India Prakash Chandran, Ph.D., India S. Chaudhury, MD, Ph.D., India Alfred Collins, Ph.D., U.S.A. Carina Coulacoglou, Ph.D., Greece C.B. Dwivedi, Ph.D, India Philip Greenway, Ph.D, Australia Somesh Gupta, M.D., India K.V. Kaliappan, Ph.D., India Arvind Keshary, Ph.D, India Anatoly B. Khromov, Russia Bhushan Kumar, M.D. India R. Kumar, Ph.D. India Sudhir Kumar, M.D. India Lisa Milne, Ph.D, Australia Mridula Mishra, Ph.D., India EDITORIAL CONSULTANTS Nalini Mishra, Ph.D., India Anjana Mukhopadhyay, Ph.D. India Paola Nicolini, M.A., Italy Paul E. Panek, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy C.S. Rao, Ph.D., India Stefano Reschini, M.A, Italy Barry A. Ritzler, Ph.D., U.S.A. Ann M. O'Roark, Ph.D., U.S.A. D. Saldanha, MD, India M.P. Singh, Ph.D, India David Sperbeck, Ph.D., U.S.A. Ramjee Srivastava, Ph.D., India Ailo Uhinki Ps.D., Finland P.K. Vasudeva, Ph.D, India Uma Vasudeva, D.H.A. India Yasho V. Verma, Ph.D., India