SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 12 Number 1 January, 2005 SIS ISSN 0971 - 6610 Vol. 12, No. 1, Pgs. 1-84 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 2005

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, 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 in chief, 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. 300, for Indian members, Institutional subscriptions are US $60. for Foreign institutions and Rs. 600 for Indian institutions. Life membership is US $300. for foreign members and Rs. 2500/- for Indian members. Non-members may subscribe for $30 or Rs. 200 per issue. Cheques should be made payable to ‘SOMATIC INKBLOT SOCIETY’ Chandigarh and should reach Dr. B.L. Dubey, Editor (Address given above). Please add $5./Rs.60/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform Mrs Padma Dwivedi, Secretory, Somatic Inkblot Center, Post Box 1107, Sector- 15 Post Office, Chandigarh - 160015 (India), Mob.: 91-94170-36655, Tel/Fax 91 - 172 - 2710986, Email: sisdubey@rediffmail.com and Foreign Members should inform Mr.Anand Dubey, Editor, 4406 Forest Road, Anchorage, AK - 99517 (U.S.A.) Tel:(907) 248-2256, 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 12, Number 1, January 2005 Contents Page Nos. 1. Editorial: SIS as an Electronic Aide to Assessment and 1-2 Therapeutic Intervention, Bankey L. Dubey 2. Presidential Addres: SIS Stimulation of Beacon Imagery, 3-8 Wilfred A. Cassell 3. Defense Mechanism Technique Modified (DMTm), DSM-III-R 9-19 Clusters and Personality Disorders in Drug Abusers, Kristian Aleman 4. Consistency of Structural Summary Scores in Computerized 20-26 Rorschach Programs, Michael J. Gournaris, Irene W. Leigh and Ross E. Mitchell 5. Impact of Number of Responses on the Interpretation of 27-48 Rorschach Indices, Bankey L. Dubey, Wilfred A.Cassell and Anand Dubey 6. Relevance of Beck Norms of Rorschach Inkblot Technique 49-52 on Indian Population-an Exploratory Pilot Study on Normal Subjects, D.K.Singh, Anjali Singh and Amool Ranjan Singh 7. Diagnostic Indicators on SIS-I and Rorschach Among Manic 53-60 and Depressive Patients, Deepak Kumar, Jagdish Kumar and Rakesh Kumar 8. Rorschach Inkblot Test in India: Historical Review and 61-78 Perspectives for Future Action, L. Sam S. Manickam and B. L. Dubey 9. 5th SIS International Conference Cochin India November 26-28, 2004.

SOMATIC INKBLOT SOCIETY is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL EALTH a half yearly publication in January and July. It started in 1994 and has published 22 issues in 12 years. The Journal is available on Society’s Web Site at http: //www.somaticinkblots.com The Journal from Volume 1-12 is available in C D (Acrobat and Page Maker) Members of Somatic Inkblot Society can get it on a nominal prize of US $50 (for Overseas Members) and Rs.1000/- (for Indian Members). The Individual and Institutional Members of Somatic Inkblot Society/ SIS Journal of Projective Psychology and Mental Health Can get the current issue and future issues of the Journal through Electronic mail free of charge Please indicate if you wish to get the Journal in Hard Copy or through Electronic mail to: B. L. Dubey, Ph.D., DPM, Editor, SIS J. of Proj. Psy. & Mental Health, P.O. Box 1107, Sector 15 Post Office, Chandgarh-160015 Mob: 91-9417036655, Tele/Fax: 91-172-2710986, E-mail : sisdubey@rediffmail.com Web Site at http: //www.somaticinkblots.com OR Wilfred A. Cassell, M.D., FAPA, APC, Editor in Chief, SIS J. of Proj. Psy. & Mental Health, Director, Somatic Inkblot Center, 4501E, 104th Avenue, Anchorage, AK 99516 ( USA) E-Mail : siscassell@yahoo.com

Editorial SIS as an Electronic Aide to Assessment and Therapeutic Intervention I feel honored to express my views as Editor of the “SIS Journal of Projective Psychology and Mental Health” through this Editorial. The Journal has reached various university Libraries in different countries. The Book “Interpreting Inner World Through Somatic Imagery” jointly authored by Wilfred A. Cassell and Bankey L. Dubey published by the Somatic Inkblot Society, has reached about 700 National and International libraries. The book is the lifetime experience of the authors emphasizing symbolic psychoanalytical interpretation of responses projected on somatic imagery of SIS instruments. The SIS is a non-profit international social organization, which promotes personality development, mental health and personal growth using somatic inkblot series images now available on the Internet (http://www.somaticinkblots.com). Practitioners strive to respond to the worldwide crisis that calls for help, through their use of the SIS. The “SIS Journal of Projective Psychology and Mental Health “ is published regularly in January and July. The Journal is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. Broadly concerned with applications in organizational, clinical, counseling, cross-cultural and health psychology settings, the Journal is distributed to Psychologists, Psychiatrists, Medical Professionals and Professional Managers interested in the understanding and modification of human behavior. I am particularly grateful to Wilfred A.Cassell, Mrs.Padma Dwivedi, Sam Manikam, Rakesh Pandey, Amool Ranjan Singh, Anil Agrawal, Paul Panek, Anand Dubey and Col. Rajinder Singh for their continuous support by contributing research papers regularly and their help to improve the quality of the Journal. I would also like to express my appreciation to all members of the Editorial Board and the authors for their contributions to the journal. The Journal is now available in CD (Acrobat and Page Maker). The CD of the Journal has found its place in various libraries. It’s a major achievement of the year 2004. We have celebrated this achievement during 5 th SIS International Conference in Kochin, Kerala (India) on November 26-28,2004. The SIS Instrument particularly 62 image SIS-II test is also available in CD. Probably in future instead of using Video, people will use the CD form of the SIS Instrument. Wilfred A. Cassell, the Pioneer of the SIS Instrument must be congratulated for a unique contribution to Psychologist, Psychoanalyst, Psychiatrist and Therapist engaged in modifying human behavior. A group of professional Psychologists conducting workshop on “Personality Development” in USA have shown interest in SIS images particularly on CD version of the Somatic Inkblot Series. We are looking ahead for the day when people interested in assessing the strength and weaknesses of their personality will visit our website to take SIS test.

The increasing usage of the various forms of the SIS in different part of the world, as well the translation of the SIS manual into Russian and Italian, is the harbinger of its global success. Normative data on students, business executives, army personnel and general population and clinical data on schizophrenics, neurotics, depressives, sexually traumatized people, drug addicts and alcoholics is available. Apart from being a tool for personality assessment and diagnosis; the SIS images have proven to be an excellent therapeutic tool. Various cases published in SIS Journal of Projective Psychology and Mental Health demonstrate its therapeutic power. The abstracts and all issues of the Journal, Manual of SIS Test, Book “Interpreting Inner World Through Somatic Imagery” and updated relevant information about SIS Society are now available at our web site (http://www.somaticinkblots.com) The use of SIS as an aide during selection and promotion interviews suggests its popularity in the area of human Resource Management. It has also been used as therapeutic aide in industry. I sincerely invite you to join this noble venture and support it by contributing research papers and institutional membership. Bankey L. Dubey,Ph.D. Professor of Psychology Editor SIS Journal of Projective Psychology and Mental Health Post Box-1107, Sector-15 Post Office, Chandigarh-160015(India) Email: sisdubey@rediffmail.com, Telefax: 91-172-2710986, Cell: 91-9417036655 2 Dubey

Presidential Address SIS Stimulation of Beacon Imagery Thank you for the opportunity to communicate with you at this 2004 international meeting of the Somatic Inkblot Society. I sincerely welcome the chief guest Prof. Jancy James,Ph.D., Vice Chancellor M.G.University, Kottayam who has spared valuable time from her busy schedule. We feel most honored and grassed by your presence. I am equally gratified to welcome his holiness Swami Poornamrithananda Puri, Amrithananamayi Math, Dr. Razeena Padmam Director, for gracing the occasion. I wish to express my appreciation to Dr Bankey L. Dubey who is so eminently qualified to carry the SIS leadership banner. I also want to thank Padma Dwivedi, Prakash Chandran as well as all those wonderful people who are making this meeting an immense success. I regret that we are unable to attend for health reasons. Although Mary and I are not present physically, we are with you in spirit. As we convene, let us take a few moments to greet all member of Somatic Inkblot Society, eminent Clinicians and Psychiatrists, Professional Psychologists, foreign delegates and students attending this conference. In order to optimize our spiritual closeness, please shut your eyes for a few moments. Begin to breathe deeply and slowly, letting a feeling of relaxation pass over your entire body. Imagine that you are gently moving down a path surrounded by beautiful SIS flowers. Visualize our seeing each other smiling, shaking hands and warmly hugging as you accept sincere encouragement for your SIS contributions. Now open your eyes to the reality of this conference. Look forward to sharing information and bonding with all in attendance. SIS technology permits us to activate specific types of images for a number of innovative clinical applications. Members of this society should be congratulated for their rich contributions to the SIS Journal of Projective Psychology & Mental Health. This meeting provides an opportunity to celebrate our journal’s eleventh anniversary, as well as its growing international scientific status. In the last decade much has been accomplished! Perhaps for a few moments we might take a trip back in time having our memories stimulated by the paper titles beginning with the initial July 1994: “The Somatic Inkblot Series Continuing Rorschach’s Conceptualization, Cross Validation of SIS-II in Psychiatric Population, Diagnostic and Therapeutic Utility of Somatic Inkblot Series-II and Rorschach, Somatic Inkblot Series in Adolescents, Reliability and Validity of Somatic Inkblot Series in India, A Study of Somatic Inkblot Series-I in Coronary Cases, Body Imagery in Vertigo Patients, Somatic Inkblot Series –I In Male Transsexuals”. Subsequent volumes of the our journal have continued covering a wide range of clinical, industrial, educational and research applications. Thanks to the technical contributions of Anand Dubey, abstracts of all volumes are now available on the web at http://www.somaticinkblots.com, as a free contribution to worldwide mind-body-spirit knowledge. Given the rich intellectual history of India, it is no accident that Indians have played a major leadership role. We expect this to grow in the future as those Indian students who have obtained doctorate degrees continue in their efforts to advance SIS knowledge.

Some may use SIS theory as a starting point to modify and refine aspects of existing technology for future, yet to be envisioned applications. There is one aspect of our conceptual model, which I would like briefly to consider for illustration purposes with the video and computer monitor presentations. These electronic based systems include an opening phase with auditory instructions concerning how to report on an answer sheet, what is seen and felt during the 62-item viewing process. These are communicated in a hypnotic like fashion with suggestions to “Relax’ setting the stage for inducing altered awareness. The underlying theoretical principle here involves creating for the viewer a trance like projective experience. This artificially replicates the solitary state of dreaming and circumvents daytime neuronal inhibition in the cortical visual areas of the brain. These viewing conditions facilitate the recall of past traumatic images and affect. Since stressful events involving high levels of trauma are recorded more permanently than nonstressful events, in the hippocampus memory neurons, this provides an innovative opportunity for floral healing. It is important in conceptualizing this projective treatment approach to emphasize the critical importance of the artificially created time-space dimensions. Instantaneously after viewing a traumatic image releasing SIS stimulus, one of the original flowers appears for a few seconds. During this period, the “afterglow” of traumatic imagery lingers or perseverates in visual consciousness. Concurrently at a physical level, the specific neurons, which previously recorded stressful memories in the hippocampus are activated releasing stress, related neurotransmitters. This process is repeated throughout the nervous system in the memory pathways related to traumatic affect. The presence concurrently of detoxifying neurotransmission chemicals triggered by the floral stimulation on these various centers can begin to initiate a restorative neurochemical healing process. At the end of the viewing procedure and to further reinforce the desensitization process anxiety reducing visual and auditory cortical centers are further activated by the presentation of visual stimulation calming nature scenes. These are accompanied by the comforting sound of Pachelbel’s “Canon in D”. Subsequently to maximize therapeutic conditioning, in repeated therapeutic sessions, the procedure may be repeated until symptoms subside. In theory this recapitulates the healing process of recurrent posttraumatic stress dream imagery. In the natural untreated state, repeated sleep experience of PTSD imagery under gradually lowering levels of neurophysiologic arousal has positive healing. Eventually over time, the original stressful scenes tend to be replaced by less threatening dream symbols. In severe cases, for maximal therapeutic efficacy, this approach may best be complimented with cognitive psychotherapy designed to correct stress based irrational memories. In such situations, the overall treatment plan might also include traditional psychopharmacological treatment aimed at synergistically restoring the neurotransmitter balance in the neurons of the hippocampus. At this meeting, I challenge graduate students and others who appreciate such projective treatment theory to consider designing custom made visual and auditory sound tracts for use in specific applications. An illustration comes to mind relating to my first trip to New Delhi in 1992. After Dr Dubey and I presented a video illustrating PTSD in an 4 Cassell

Alaskan state trooper, a senior police leader asked me during the subsequent question period, “How can this technique help me with my staff here?” He was made to understand how SIS images help in releasing the unprocessed painful material accumulated by police officers. In redesigning the original SIS system, one could surely do without the initial FBI warning about copying the tape in vivid red at the beginning. Clearly it would be more conducive to inducing a hypnotic state to have language, pictorial presentations, and sound tract more consistent with an Indian policeman’s cultural and professional life traumatic experiences. Obviously as well, it would be more operationally effective to conduct interviews and SIS assessment with the present system in traumatized Indian law enforcement and military personnel. These could provide guidelines for developing more specific and therapeutically powerful occupationally and culturally specific SIS stimuli. Please feel free to use your imaginations and development skills. Additionally, it might introduce additional therapeutic potency by stimulating olfactory centers through the concomitant use of fragment like flower smelling perfumes. When possible, consider working in association with those who have access to modern neuro-physiologic monitoring systems. As we gradually move further into the 21st century, the direction of focus for some SIS scientists might well move beyond the clinical model. Scientific investigation of all forms of simagery throughout normal healthy development, the reproductive cycle and into aging could also prove fascinating. SIS technology has a great power to stimulate brain mechanisms, which are experienced in consciousness as various types of mental pictures. We are challenged to establish consultative team relationships with neuroscientists in order to utilize modern neurological techniques to identify the underlying brain mechanisms of imagery. We also need to develop new mathematical models to decode symbolic messages from “Mother Nature’s Mental Movies”. Even though we might rely on technical state of the art scientific equipment, we will always retain our deep reverence for their natural spiritual source. There are many noteworthy instances where the sudden appearance of inspirational mental images have advanced scientific knowledge and dramatically transformed the power of humans to shape the world - albeit for good or evil. Dreams and related altered states of awareness such as in Yoga provide a rich source of examples. One that I frequently have cited in my clinical practice to illustrate the importance of monitoring dreams for inspirational thoughts might be worthy of brief consideration. It involves the chemist who was attempting to understand the chemical interactions of a six carbon molecular chain. One night he dreamt of a snake that bit its tail forming a ring like pattern. This startled him and he awoke thinking about the significance of the symbolism. Then for the first time, he realized that benzene existed in the form of a ring structure. Apart from dreams, inspirational imagery may appear on the gifted individual’s psyche “movie screen” in full daytime consciousness. Frequently the person may not be immediately attempting to solve a particular problem, but instead be walking in nature, enjoying music or enjoying some other form of relaxation. Such activities tend to momentarily provide a window of opportunity for the brain mechanisms activating beacon imagery. Presidential Address 5

As we approach 2005, one outstanding example is Albert Einstein. His life and work were recently reviewed in the August 2004 Discovery publication to which I am heavily indebted to for the following information. It can be visited on the web at www.discovery.com. In this publication Christof Koch, professor of computation and neural systems at Caltech noted that he admired him for the following reason: “What I admire most about Einstein the scientist was his ability to reason very clearly and quantitatively in pictures – in his head. He exploited this iconic thinking to maximal effect with his famous Gedanken experiment, thought experiments, involving elevators, light beams, railway cars, observers and the like. But Einstein was quite different from philosophers, who by and large abuse that process and draw absurd conclusions from it. Einstein’s intuitions led to quantitative results and have been quantitatively verified. It could be argued that he was better at this than any other person, dead or alive”. As a little boy Albert grew up in Ulm, Germany at the end of the 19th century. At sixteen he became interested in science - especially physics. In studying gravity, he conjured up images of himself in free fall play situations, with its unique somatic sensations of weightlessness. In addition, like many youths, he frequently focused on his changing adolescent body image. Related to this he wondered “What would I see in a mirror if I were traveling as fast as light?” A third picture seeded his later life scientific theorizing. This scene involved visualizing from a distance a speeding train, with an engineer looking out while lightning simultaneously struck the engine and the caboose. In considering this mental problem, he wondered if the man on the train would see what he would see (i.e. two bolts of electricity striking at the same time). Over the first half of 1905 at age 23, after considering the significance of these earlier mental images and what they really meant, he published major papers. These explained Brownian motion and the reality of atoms creating the quantum theory of light and most famously, inventing the special theory of relativity. Soon afterwards he contributed his now famous equation E=mc2. It soon will be the 100th anniversary of his classical publications. In writing about his use of relatively simplistic image models in the August 2004 issue of Discovery, Thomas Levenson observed: “Einstein viewed space and time like a child. The measure of his genius is that he could both invent such absolutely stripped down images and then go further, to work out what those pictures actually meant.” Perhaps if we take a moment or two to review his life, we might acquire certain insights regarding the fundamental nature of his inspirational imagery. First of all it might be worthwhile to consider his unique genetic characteristics. Since his second son, Eduard suffered from a schizophrenic breakdown at age 20, it may be inferred that he fitted into the category of unusually talented individuals who carry a DNA diathesis to develop this disorder. Much has been written about the relationship between genius and madness. It may be hypothesized that certain forms of DNA stimulate central nervous system mechanisms activating imagery in general. Perhaps for Albert, his DNA gave his brain unusual ability in generating the previously outlined inspirational, yet simplistic child like image based mental models of the physical world. Consistent with this are studies 6 Cassell

suggesting that there are subtle electrical processes in the central nervous system of apparently healthy family members. However for Eduard, it would seem that a defect in his DNA made his consciousness vulnerable to being flooded with cognitive disrupting imagery. Investigators might find it potentially rewarding to investigate SIS imagery in the healthy individuals of those families burdened by those suffering from Schizophrenic Disorder. Talented children in such families could be identified early on to put into enriched educational programs to develop future leadership potential. Next we might consider how his educational experiences might guide us in developing optimal formal training for expertise in SIS work. Brad Lemley reported “young Albert excelled in mathematics. From the age ten he conversed as an equal with Max Talmey, a Polish medical student and weekly lunch guest at the Einstein’s. Talmey fed Albert’s voracious curiosity with books. He was particularly interested in works by Aaron Bernstein, whose writings discussed the idea that a unified force underlay all natural phenomenom”. Clearly early intellectual stimulation facilitates the growth of the nervous system and fuels future creative thought. If there is a additional lesson here, it is that we need to identify talented students and select for SIS training those with high levels of curiosity. Interestingly enough, it is sometimes important not to give too much weight in the selection process to negative predictions by former professors. Relative to this, “disgusted by Albert’s inability to learn Greek, his professor at Munich’s Luitpold Gymnasium reportedly told him in front of the class that he would never amount to anything”. Similarly when he completed his formal training, his professors did not recognize his intellectual power to pursue the hidden meaning of simplistic imagery in physics. They refused to support his desire for a university position and ultimately he was forced to take a low level position processing patents. While we desperately need to get promising young graduates involved in the many fascinating fields of SIS work, let us not miss promising young people who might have been undetected in the formal university system. We need to recognize genius early on and develop educational programs to foster their growth, as well as giving them economic, occupational and psychological support. In most cultures talented individuals are vulnerable to a variety of stress induced illnesses. Einstein in 1917 collapsed in agony from a stomach ulcer and lost 56 pounds in two months. Closer to our field, Herman Rorschach died at age 37 from a ruptured appendix. He initially had declined to seek treatment and was depressed over the lack of acceptance of his inkblot methodology. In the west, gargantuan athletes, many of whom are relatively unintelligent are financially rewarded far out of proportion to what they contribute. Their incomes seem obscene, when viewed from the meager support received by the intellectually endowed. Clearly financial issues pose obstacles for advancing SIS heuristic work. Unlike the psychopharmaceutical industry, our research budgets are too limited. I hope that there is an opportunity at this meeting to address this issue and come up with helpful recommendations. A final characteristic of Einstein’s brilliance was his ability to stubbornly stick with solving a problem and challenging existing forms of thought. Prior to Einstein, Newtonian views of what constituted time, space, matter, energy and gravity had prevailed for a Presidential Address 7

lengthy period. We need young SIS workers with similar characteristics who are ready, willing and able to challenge existing theory and approaches. Let us not make the same mistakes that the archaic stimulus bound Rorschach people have made in their work and training of psychologists. Another brief lesson that might be gleaned from studying Einstein’s life involves the perpetual need to be cautious about making dogmatic declarations in print outside our immediate SIS scientific field of expertise. In one of his last professional opinions, he grossly erred in writing a positive forward to Charles Hapgood’s book, which scorned the now generally accepted geologic theory of shifting “plate tectonics”. Prior to his death in 1955, in a more contemplative and philosophical frame of mind, Einstein revealed his ambivalence about the implications of his earlier work as follows: “The release of atom power has changed everything except our way of thinking…the solution to this problem lies in the heart of mankind. If only I had known, I should have become a watchmaker.” If he were alive today, he might add concerns about the destructive potential of antiscientific religious fanatics, who not only may have access to nuclear weapons of mass destruction but also to chemical and biological ones. Unlike physicists, members of this society are in a better position to understand both the good and the evil aspects of the human heart. We need to advance our ideas and begin to play an enlightened leadership role in our culture. Please make the most of your opportunity to be stimulated by fresh ideas and intellectual challenges at this important meeting. We need to continue having a social conscience in using SIS technology in innovative clinical work. However, in futuristic planning, let us also keep in mind Einstein’s thinking about the value of heuristic projects “Es ist ein grofser Irrtum, zu glauben dafs Freude am Schauen und Suchen durch Zwang und Plichgefuhl gefordert warden konne” translated as “It is a grave error to suppose that the joy of seeing can be furthered by compulsion or sense of duty”. I sincerely pray that you will continue your excellent work and have the intellectual courage to extend the boundaries of SIS knowledge into ever more fruitful areas! Wilfred A. Cassell, MD, FAPA, APC, President Somatic Inkblot Society, Editor in Chief-SIS Journal, SIS Center, 4501E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E-Mail: siscassell@yahoo.com 8 Cassell

Defense Mechanism Technique Modified (DMTm), DSM-III-R Clusters and Personality Disorders in Drug Abusers. Kristian Aleman In the present investigation, the aim was to see how signs of DMTm (Defense Mechanism Technique modified) related especially to DSM-III-R clusters, but also to personality disorders on its own (independently of cluster) and in relation to drug abuse (heroin/amphetamine), depression and panic disorder. The group studied was 65 non-psychotic, but severe, drug abusers, 36 drug abusers injecting heroin and 29 injecting amphetamine. The results of DMTm signs (i.e. signs of defense mechanisms, different kinds of anxiety and “additional” signs) showed statistical significance of projected introaggression in relation to cluster A (n=15, called “Odd”) and inhibition proved to be significant in cluster C (n=22, “Fearful”). Furthermore, the results showed significance of introaggression, barrier isolation and disappearance of threat in borderline personality disorder (n=8) on its own. Finally, correlation between affect isolation and panic disorder was seen. All these results were interpreted using Andersson psychoanalytic model of the mind. The psychoanalytic interpretations of this study may provide guidance in planning treatments of drug abusers. DMTm (Defense Mechanism Technique modified, Andersson, 1991) is a perceptgenetic technique developed and modified from DMT (Defense Mechanism Test, Kragh, 1969). Both clinical and non-clinical investigations have frequently been studied with DMTm. The clinical ones are more of relevance for the present investigation, which concerns personality assessment, especially those of defense mechanisms in drug abusers. DMTm-investigations concerning aspects of this investigation’s research area of drug abuse, personality disorder, depression and panic disorder are presented below. Hallborg et al. have investigated depressive symptoms of different kinds (Hallborg, 1997; Hallborg & Andersson, 2002) while Petersson et al. have studied young adult patients with adjustment or personality disorders (Petersson, Andersson & Nilsson, 1997). Other studies using DMTm concern current or earlier drug abuse (Bergström, 1998), the psychoanalytical motives of the drug of choice (Andersson & Montgomery, 2004), patients with panic disorder and agoraphobia (Bogren et al., 2002) and finally, differences in DMTm between psychotic and non-psychotic drug abusers (Aleman, 2004). In the latter study, defense mechanisms in psychotic drug abusers were primarily investigated. In the present study, therefore, defense mechanisms in non-psychotic drug abusers were in focus. This study is a comparison mainly of the DMTm signs in groups of drug abusers with the DSM-III-R clusters (Diagnostic and Statistical Manual of Mental Disorders, Third Edition – Revised, 1987), A, B or C, which has not so far been studied. Other purpose of this study is to investigate the DMTm signs in drug abusers with separate personality disorders of DSM-III-R, axis II, independent of the DSM-III-R clusters. The third purpose was to study DMTm signs of drug abusers with DSM-III-R, axis I diagnoses, drug abuse (heroin/amphetamine), depression and panic disorder. Also, SAT (Spiral Aftereffect Technique, Andersson, 2004) classifications were studied in drug abusers with different DSM-III-R clusters. Kristian Aleman, Vidargatan 5, entréplanet, 113 27 Stockholm, SWEDEN, Telephone: + 46 8 32 82 08, Email:kristian.aleman@ka-psychoanalysis.se. Key Words: DMTm, drug abuse, DSM-III-R cluster, personality disorder, psychoanalysis.

The general purpose of present study was to investigate defense mechanisms in nonpsychotic drug abusers, especially the specified motives behind particular defense mechanisms as per Anderssons (1991) psychoanalytic model of the mind. This may increase the understanding of defense mechanisms and the motives behind them, which can improve treatment of drug abusers. Intention of this study was also to compare the results of the present empirical investigation with results of other empirical investigations, viewed from DMTm, but also DMT. The first hypothesis was that DMTm sign/-s would be characteristic significantly for DSM-III-R clusters, consisting of different personality disorders (cluster A, called “odd”, B for “dramatic” and C, “fearful”). The second hypothesis was that DMTm sign/-s would be characteristic significantly for personality disorders on its own. The third hypothesis was that DMTm sign/-s would be characteristic significantly in relation to drug abuse (heroin/amphetamine), depression respectively panic disorder. To obtain a more inclusive personality description of an individual, DMTm is often complemented by use of the SAT, which aims at providing a description of basic personality characteristics. The fourth hypothesis was that any of the basic personality characteristics, or rather classifications would show significance in any of the clusters of personality disorders. Methods : Patients : 65 drug abusers who all injected drugs, were gradually recruited during the years 1994-96 from the drug abuse clinic of Sabbatsberg hospital in Stockholm, Sweden. At that hospital, the criteria for diagnosing drug dependency or drug abuse that appear in ICD 9 (International Classification of Diseases, Ninth Edition; World Health Organisation, 1987) was used, although the patients likewise conformed to the criteria for this diagnosis contained in DSM-III-R. Five psychiatrists were encouraged to and educated in applying DSM-III-R, axis II, concerning assessment of personality disorders in these 65 drug abusers. Three clinical syndromes on axis I, drug abuse (heroin/amphetamine), depression and panic disorder were also assessed. A control that no one of the five psychiatrists had an overweight to diagnose a particular personality disorder, because of “a favourite diagnose”, was performed. The patients had all been drug dependent for at least five years and could be described as being basically abusers of heroin or amphetamine alone. The aim was here to have a balanced frequency between the two different drug groups. All the patients had taken large doses of the drug daily, although some had abused alcohol, cocaine or benzodiazepines for periods of time. All of them were recruited from one examination and motivation unit for non-psychotic drug abusers. The exclusion criterions for recruiting the patients were diagnoses of brain damage and uni-/bipolar mood disorders. At the time of testing with DMTm and SAT, all of them had been drugfree for at least four weeks, and DSM-III-R diagnoses were assessed shortly after these tests. The median age and age range, respectively, were 32 and 23-43 years for the 36 subjects in the heroin group (11 women and 25 men) and 31 and 21-43 years for the 29 subjects in the amphetamine group (8 women and 21 men). 10 Aleman

The patients were (independently of drug of choice) distributed in three clusters depending on the personality disorders. No overweight of either a specific drug, deviation of age or sex was seen in the three clusters. Cluster A (n=15) consisted of following personality disorders: paranoid (n=8), schizotype (n=3), schizoid (n=4). Cluster B (n=22) consisted of: borderline (n=8), histrionic (n=5) and narcissistic (n=9) personality disorders, while cluster C (n=22) consisted of phobic (n=6), dependent (n=7), obsessivecompulsive (n=6) and passive-aggressive (n=3) disorders. The number of patients with assessment of UNS (unknown, or combinations of different personality disorders with no apparent dominant one) was 6. Note the criterions for anti-social personality disorder, normally in cluster B, were fulfilled by 53 patients out of 65. The drug abusers in this investigation were heavy intravenous drug abusers, also involving high criminality etceteras. In this study, anti-social personality disorder was seen not as a specific personality disorder by itself, but a very common state among heavy drug abusers. Because of the vast number of different personality disorders, the number of patients in each personality disorder was too little to be able to study the differences. Therefore, and to minimize the frequency of variables, only the three largest groups, i.e., narcissistic (n= 9), borderline (n= 8) and paranoid personality disorders (n= 8) were run for statistical analysis. Spiral Aftereffect Technique : According to Andersson’s (2004) manual of SAT (and DMTm), the test person first gazes for 45 seconds at a rotating spiral line, rotating so that the spiral appears to be moving inwards. Directly after watching it, the person is shown a circle that, objectively speaking, is standing still but is perceived as either growing larger or coming closer, due to the person’s projecting onto the circle the aftereffect of the rotating spiral. The person indicates when this aftereffect has ceased, the test administrator noting how long the aftereffect lasted. Ten successive trials of this sort are carried out, the times that are registered being used to assess the person in terms of a special personality classification. The task in SAT is in principle being that of recreating the “preferred” relationship between subjective reality (the experienced aftereffect) and objective reality (the unmoving circle upon which the aftereffect is projected). How this task is solved is termed the SAT strategy. It manifests itself either as a successive decrease (minustrend, or -), as a successive increase (plus-trend, or +) or as no appreciable trend in either direction (zero-trend, or 0). The preferred relationship between subjective and objective reality, assessed as the mean of observations 9 and 10 (final level) is termed the person’s SAT identity. If the duration of the aftereffect is extremely short throughout, as judged on the basis of norms that have been established, the classification LLs (”Low Low short”) is employed. Additional classifications employed are LL (a very low final level, always involving a minus strategy, which for that reason is not indicated by use of a minus-sign), L- or L+ (a low final level involving the trend that is indicated), H- or H+ (a high final level, again involving the indicated trend) and M-, M+ or Mo (an intermediate final level involving the trend that is indicated). Defense Mechanism Technique Modified : DMTm is designed to facilitate interpretation of the results in terms of the Andersson Defense Mechanism Technique 11

(1991) model of the mind. An important aspect of this model is that motives (and even specified motives) for defense can be derived from developmental positions, and that two basic types of defenses are to be found: instrumental and relational. Instrumental defenses are also termed affect defenses. Relational defenses are also termed identity defenses and they are of two types: denial and denial through reversal. The specified motives behind a particular defense can be obtained from different psychoanalytical models. The specified motive behind denial is derived from Freud’s (1900) reflex-arc (attachment) model; the specified motives behind denial through reversal from Kohut’s (1971, 1977, 1984) model of self/selfobject and the specified motives behind affect defenses from Klein’s (1935, 1940, 1946) affect positions model. Two different picture-motifs are shown in a tachistoscope. First the one motif and then the other is shown in a series of 20 expositions each, the exposition time increasing successively in each series from 5 to 1150 milliseconds. After each exposition, the person’s task is to report what he/she has seen or experienced, doing so both verbally and by making a simple drawing. This results in a total of 40 such reports, 20 for each picture-motif. At the centre of both pictures, a young person of the same sex as the test person can be seen. This person, termed the hero or heroine (H), is also provided with a disguised sexual attribute (A). Shown in a peripheral position in the picture is an older person of threatening appearance, who in the first picture is a woman (“the threatening mother”) and in the second picture a man (“the threatening father”), termed in both cases the Pp (peripheral person). When the test person deviates from “correct” reporting of the content of the pictures, it is of primary essence. Some deviations are interpreted as signs of defense and others as signs of anxiety. Still other deviations, referred to in the manual (Andersson, 2004) as “additional signs”, are interpreted as signs neither of defense nor of anxiety. It is primarily within this category that, in this investigation and in others, “new” signs such as that referred to here as “disappearance of threat” has been explored. The DMTm protocols obtained were coded by professor A.L. Andersson (who had no knowledge of how subjects were grouped) and by the author of this research paper, independently of each other. In those few cases in which our codings failed to coincide, we reached agreement prior to the start of data analysis. To minimize the frequency of variables, DMTm was used as a whole, i.e. one can found DMTm signs in either series 1 alone, in series 2 alone or in both series 1 and 2. This procedure resulted in the use of 19 dichotomous variables. These mentioned variables had at least five individuals/signs each. That number of Individuals/signs in each variable was assumed to be minimum for statistical analysis. These signs were involved: anxiety 1-3; repression 1-3, 4-6 and 7-8; projected introaggression 1-2; introaggression; inhibition 1-2; isolation 1-2 and 3-4; denial 1-3; denial through reversal I 1-2, II 1-3, III 1-4, IV 1-8; splitting; H positive; H afraid; disappearance of A and disappearance of threat. The content of the different DMTm signs reported in the table of results (Table 1) is described here: 12 Aleman

Affect Defenses : Projected introaggression. Pp being seen as injured, tormented, dejected, sad, frightened, worried or exposed, or A being seen as something which is damaged, broken, worthless, bad or threatening. Inhibition. On at least five consecutive exposures, Pp being seen as a petrified, inanimate or disguised being that is neither threatening nor unpleasant, or as a specified object (repression at the place of Pp not scored here), or on at least five consecutive exposures, Pp being seen as an object distinguished by its contour or as a framed, empty surface (barrier isolation not scored here). Introaggression. H being seen as injured, wretched, in trouble, or the like, or as being critical toward the self or involved in a situation of destructive character. Barrier isolation (1-2). A barrier being added between H and Pp or H and Pp belonging to different realities, or Pp being seen as a framed, empty surface or as an object distinguished by its contour. Affect isolation (3-4). Pp being seen as a white or shining object or surface, or there being a total loss of the specified content in the exposure preceding the loss. Additional sign: Disappearance of threat. Denotation of threat being missing on Pp on at least two consecutive exposures after an earlier indication. Statistical Analysis : Statistical comparisons concerning DSM-III-R clusters involve fourfold tables and twotailed testing with use of the chi-square test. The remaining ones involve fourfold tables and two-tailed testing with use of the Fisher Exact Probability Test. Results : The SAT classifications that were applied in the present investigation were allocated in following combinations: LLs and Mo (n= 7); LL (n= 17); L- (n= 23); M- (n= 9) and L+, H+ and M+ (n= 7). The results of these classifications showed no significance in any of the clusters of personality disorders. The first hypothesis, on the other hand, was significantly confirmed, that DMTm sign/- s would be characteristic for clusters consisting of different personality disorders, i.e. A (called “odd”), B (“dramatic”, not significant) and C (“fearful”). The second hypothesis was also statistically significant (in borderline and narcissism, but not in the paranoid ones), that DMTm sign/-s would be characteristic in personality disorders of its own. Even the third hypothesis was partly confirmed that DMTm sign/-s would be characteristic in relation to panic disorder, depression and drug abuse. Only panic disorder became statistically confirmed (NB: depression correlated significantly with borderline, but not in relation to any DMTm sign, se table 1). Note in table 1: significant results in italics and the first number in the distribution indicates the frequency of patients who have the sign in question, the second number, the frequency of patients who lack the sign. Defense Mechanism Technique 13

Table 1 DMTm Signs in DSM-III-R Axes I, II and Clusters DSM-III-R DMTm Distribution P Axis I Axis II Signs = Cluster A (n=15) Projected introaggr. 7/8 X2 = 6.98 p = Cluster B (= 22) 2/20 .03 Cluster C (= 22) 5/17 Cluster C (n=22) Inhibition 5/17 X2 = 6.50 p = Cluster A (n=15) 1/14 .04 Cluster B (= 22) 0/22 Narcissism Introaggression 0/9 p = .01 Not narcissism 31/25 Borderline (n=8) Introaggression 8/0 p = .0002 Not Borderline 17/40 Borderline (n=8) Disap. of threat 5/3 p = .01 Not Borderline 10/47 Borderline (n=8) Isolation 1-2 5/3 p = .03 Not Borderline 12/45 Panic Disorder Isolation 3-4 8/12 p = .005 Not Panic Dis. 4/41 Depression Borderline (n=8) NB. No Sign 6/2 p = .01 Not Bordeline 15/42 The statistical analysis of cluster A, B and C has df=2, the remaining ones, df=1 Discussion : SAT classifications did not show any significant results in the present investigation. It may have been too many variables (5 SAT classifications) with too small numbers of patients in some of the SAT classifications for this material. Cluster A (called “odd”), consisting of paranoid, schizotype and schizoid personality disorders, these 15 drug abusers were more prone to reconstruct the affect defense of projected introaggression in the DMTm than in comparison with clusters B and C. According to Andersson (1991), projected introaggression (and repression) is derived from the first developmental position of the psychoanalytic model of the mind. Defense from this position is interpreted according to the affect positions model by Klein (1935, 1940, 1946), like in position 2 and 3. In chronological order, the following developmental positions are named: paranoid-schizoid (position 1), depressive (position 2) and manic-obsessive (position 3). The specified motive behind projected introaggression is interpreted from the paranoid-schizoid position. It can be described as a strategy to project self-destructive components in anything or anybody outside the central self. This is a deficiency to contain the evil inside. One specific dilemma in this position is that the drives are following the principle of repetition, almost like a drug in itself, an impasse. However, it is an evil unconditional state of mind that the 15 drug abusers in cluster A have to deal with here. 14 Aleman

In one investigation (Christensson, 1990) of twenty-two suicide attempters, the DMTm sign of projected introaggression was found in one of the four subgroups that crystallized from a Q-factor analysis. In 1996, Ghaffari investigated female refugees from Iran, who were interviewed about childhood, relation to parents etceteras. It was shown that projected introaggression correlated to women who experienced their father as being kind, not aggressive. Furthermore, Bergström (1998) also found projected introaggression in a group of female drug abusers, especially those who were rehabilitated. Typical for those female drug abusers, who were abusing drugs actively, was almost no symbolization in DMTm at all. They showed no signs of both affect or identity anxiety and no more than a single type of affect defense. Lastly, but in DMT (Defense Mechanism Test, Kragh, 1969), Sundbom (1992) made a statistical discriminant analysis to find characteristic signs between neurotic, borderline and psychotic patients. In this study, more prevalence of projected introaggression in the group of psychotics observed. This is of interest though cluster A also can be called “spectrum diagnosis”, i.e. the patients in cluster A are not necessarily far from being diagnosed as (pre-) psychotic. That is not the fact with patients in clusters B and C. The DMTm sign of inhibition was significantly more obtained in cluster C (the 22 “fearful” drug abusers; phobic, dependent, obsessive-compulsive and passiveaggressive personality disorders) than in comparison with drug abusers in clusters A and B. Inhibition is derived from position 2 in the Andersson model of the mind, the depressive position (see below “introaggression”) Hallborg et al. (1987) found inhibition in one of the two main factors, “strain neurotics” (the other main factor was “organ neurotics”) of hypochondrias. In an investigation (Andrée & Marke, 1994), one found inhibition more frequently obtained in patients with total ulcerous colitis than those with distal colitis. Andersson & Ryhammar (1998) were investigating 132 university teachers according to DMTm, SAT and CFT (Creative Functioning Technique; Smith & Carlsson, 1989). Among all results they found inhibition (and affect isolation) in those teachers who were not creative at all. Finally, in a study of 14 hospitalized psychiatric patients, Sjöqvist (1996) applied a half-structured interview, KAPP (Karolinska Psychodynamic Profile) and DMTm. Low scoring in the KAPP scale (lower degree of psychic disorder) was related to inhibition. Concerning personality disorders on its own, it was totally clear that drug abusers diagnosed as borderline showed much more introaggression (p = .0002) and depression than anyone else. Sharma (1977) points out how commonly assumed it is that introaggression in the DMT is associated with a depressive condition in a clinical sense. Introaggression could be seen as a discriminant DMTm sign between borderline and narcissism, though drug abusers diagnosed narcissistic personality disorder had not introaggression at all (p = .01). In DMTm, the specified motive behind introaggression (and inhibiton, see above) is derived from position 2, the depressive position. Typical for this state of mind is when the child develops emotionally, from relating to part objects to whole objects. This means that the child experiences new qualities in the (whole) relation, which is more driven from realities. This evokes conflicts. The child can suddenly feel ambivalent emotions against the loved object. The child’s love and hate are now directed towards Defense Mechanism Technique 15

the same whole object. What is emphasized in this position is that the child could not protect the loved parent from its hate. This condition mobilizes feelings of guilt. One unhealthy variant is to direct this hate towards the self (introaggression) to protect the parent. In the long run this procedure creates a damaged and diffused self that specifically, in this empirical investigation, concerns those drug abusers diagnosed as borderline. Similar finding has been observed in Sundbom’s (1992) investigation of characteristic DMT signs between neurotic, borderline and psychotic patients. The borderlines reacted with introaggression significantly more than the comparison groups. Concerning DMTm, Hallborg et al. (1987) were studying hypochondriacs, 24 out patients clinic. Among other results, introaggression was significant in one group called “organic neurotics”, who complained over heart problems. Hallborg’s investigation (1997) of depressed patients, reports findings that there is a correlation between the factor, “Thoughts of suicide” and introaggression and/or projected introaggression. This result only concerned women. Bogren et al. (2002) were investigating 23 patients with both panic disorder and agoraphobia. They found that introaggression was significant for panic disorder but correlated to low scoring in the questionnaire of phobia. There were also other significant results concerning borderline personality disorder on its own, barrier isolation and disappearance of threat. They obtained more frequently the DMTm sign barrier isolation than the others. The root, or motive behind this defense, is derived from the same position as introaggression, namely position 2, the depressive position. Sundbom (1992) noted that borderlines reacted more with isolation (together with other defenses) in DMT, than neurotics and psychotics. She is arguing one interesting aspect of barrier isolation, namely its connotation to more “primitive” defense. Sundbom wonders if isolation is more of an expression of ego-deficiency with primitive defensive operations centring on the mechanism of splitting or denial. However, in the development of DMTm, splitting is already empirically constructed. Even more interesting, one does not emphasize primitive or mature defenses in DMTm, because they can be obtained in other groups than clinical groups and do not necessarily need to be an expression of primitive meaning. In 1993, Sand gave DMTm and SAT, also, among other questionnaires, PONS (Profile of Non-verbal Sensitivity) to 51 women, under assistant nurse education. Barrier isolation was correlated to worse capacity of understanding non-verbal communication. Disappearance of threat is an additional sign in DMTm. That means it is still under empirical evaluation and has not yet a definitive position in the Andersson psychoanalytic model of the mind. However, this sign was clearly significant in drug abusers diagnosed as borderline. Is this “disappearance of threat” an unconscious attempt to reduce violence and anxiety in object relations? In that case, consequences must then be unstable object relations coloured by difficulties with aggressiveness. Westerlundh (1976) means that when disappearance of threat shows up in the DMT, he states that it is “an anxious, ambivalent need to meet an aggressive object” (p. 172). In a study conducted by Holmberg & Olsson (1994), the aim was to see if there were any correlations between DMTm, sex, ADHD (Attention Deficit Hyperactivity Disorder) and the questionnaire; “I think I am…” in youngsters under the Swedish welfare system, “the law of care of youngsters”. Typical DMTm sign constellation for ADHD was, denial 16 Aleman

through reversal I, II and/or III, together with disappearance of threat. When evaluation in the questionnaire form showed “low relation to others”, there was a correlation with disappearance of threat. The result that showed significance, not in relation to any cluster nor personality disorder on its own, but in relation to panic disorder, was the DMTm sign of affect isolation. That means, of those drug abusers, independently of cluster and personality disorder on its own, who reconstructed affect isolation in DMTm significantly had panic disorder (p= .005). The specified motive behind affect isolation is derived from position 3 in the Andersson psychoanalytic model of the mind. This position, manic-obsessional position (Klein, 1935, 1940) is, in the model, corresponding to position 1. It involves the inner unconditional evil. The prototype of state of mind here is a paranoid, schizoid world. While in position 1, the typical way in percept-genetic reconstruction to handle this evil, could be described as “reification”, connected to repression, while in position 3, it is more about “annihilation” (connected to affect isolation) of the evil. Like in DMTm, when one expression of affect isolation is to whitening the whole picture (annihilate the evil/aggressive Pp), it is described by Klein as scotomization, i.e. a blind spot for the psyche, something threatening that the mind cannot handle. In the most extreme variant of this annihilation, it can be directed towards the self, resulting in suicide. It involves doubt about one’s capacity to contain evil impulses and simultaneously fear for losing control over one’s aggressions. It seems like affect isolation is a percept-genetic expression for those drug abusers who were diagnosed to be having panic disorder. Hallborg (1997) conducted an empirical investigation of 53 depressed patients, affect isolation (also barrier isolation) was significantly correlated to one of the factors, “heredity”. This result concerned the female patients. In Hallborg & Andersson’s (2002) follow-up study, affect isolation proved to be of relevance in the factor of “thoughts of suicide”. In an investigation (Andersson & Montgomery, 2004), of 128 heavy drug abusers, affect isolation was one of the significant results. It was typical for 30 females using heroin, together with 32 males using amphetamines. Finally, the first and second hypotheses were statistically significant. The third hypothesis was partly confirmed. The fourth hypothesis was not statistically significant. If any researcher will replicate this investigation, it is important to increase the number of patients in the groups of personality disorders by it self. With regard to dividing the total number of patients into many different personality disorders, 65 drug abusers are not enough for statistical analysis. One way of meeting this problem has been to limiting the statistical analysis only to the three largest groups of personality disorders. This procedure can be assumed to be accepted. On the other hand, the number of patients in the clusters was satifactory for statistical analysis. The disadvantage of this study is that many statistical comparisons have been performed before reaching these results, even though ambitions have been made to minimize it. For instance using DMTm as a whole, meaning fewer variables and using only the three largest groups of personality disorders, instead of the original 10 groups. The risk of many statistical comparisons is that, in worst case, the null hypothesis will be produced. In other words, one interprets results as significant, but there are in fact no significant results in reality (for a more detailed discussion of possible statistical problems with DMTm, see Aleman 2004, p 30-31). With respect to this potential problem, the results of this study should be interpreted carefully. Defense Mechanism Technique 17

In this investigation of non-psychotic drug abusers, affect defenses have been found characteristically for clusters A and C, personality disorder on its own and in relation to panic disorder. One additional DMTm sign also showed meaning in personality disorder on its own. Hopefully, with help of the Andersson psychoanalytic model of the mind, a wider scope of understanding drug abusers can be achieved. In future, perhaps, improvements can be implemented when treatments are going to be planned. References : Aleman, K. (2004). Differences in Terms of the Defense Mechanism Technique Modified (DMTm) Between Psychotic and Non-psychotic Drug Abusers. SIS J. Proj. Psy. & Ment. Healt, 11: 25-35. American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Revised). Washington DC: Author. Andersson, A. L. (1991). Percept-Genesis and Personality. Sweden: Lund, Lund University Press. Andersson, A. L. (2004). Spiral Aftereffect Technique (SAT) and Defense Mechanism Technique Modified (DMTm). Sweden: Lund University, Department of Psychology. Andersson, A. L. & Ryhammar, L. (1998). Psychoanalytic Models of the Mind, Creative Functioning and Percept-Genetic Reconstruction. Psychoanalysis and Contemporary Thought, 21, 359-382. Andersson, A. L. & Montgomery E. (2004). Drug of Choice as Related to Percept-Genetic Reconstruction of Personality in Terms of the Spiral Aftereffect Technique (SAT) and the Defense Mechanism Technique Modified (DMTm). Psychoanalysis and Contemporary Thought, 27. In Press. Andrée, S. & Marke, K. (1994). Ulcerous Colitis and Affect Regulation. A Percept-Genetic Study with SAT and DMTm in Combination with Interview. Thesis, Psychology Examination, Sweden: Lund University, Department of Applied Psychology, 8, No 19. Bergström, M. (1998). Three Realities. Women in Different Phases of Drug Abuse. A Social Psychological Investigation. Doctoral Dissertation, Sweden: Department of Applied Psychology, Lund University. Bogren, L. Bogren I.-B., Orth, T. & Sjödin, I. (2002). Panic Disorder and the Defense Mechanism Test. Nordic Journal of Psychiatry, 56, 195-199. Christensson, P. B. (1990). A Percept-Genetic Study of Suicide-Attempters in Terms of SAT and DMTm. (Psykologi i tillämpning, 8, No. 2). Sweden: Lund University, Department of Applied Psychology. Freud, S. (1900). The Interpretation of Dreams. Standard Edition, 4-5. London: Hogarth, 1953. Ghaffari, F. (1996). DMTm Signs in Iranian Women and Perception of Childhood and Their Relation to Parents. Thesis, Psychology Examination, Sweden: Lund University, Department of Applied Psychology, 13, No 1. Hallborg, A. (1997). Relations Between Symptom Dimensions in Depression and DMTm Signs. (Psykologi i tillämpning, 15, No. 4). Sweden: Lund University, Department of Applied Psychology. Hallborg, A., Andersson, A. L., Nordgren, L., & von Schéele, C. (1987). A Percept-Genetic and Clinical Study of Patients with Hypochondriac Complaints. (Psykologi i tillämpning, 5, No. 2). Sweden: Lund University, Department of Applied Psychology. 18 Aleman

Hallborg, A. & Andersson, A. L. (2002). Spiral Aftereffect Technique (SAT) and Defense Mechanism Technique Modified (DMTm) After Recovery From Depression In Relation to Symptom Dimensions and Personality Reconstruction Under the Acute Situation. (Psykologiska Rapporter från Lund, 3, Nr 2). Sweden: Lund University, Department of Psychology. Holmberg, J. & Olsson, A.-L. (1994). A Study with DMTm of Twelve Youngsters in Need of Care According to The Law of Social Welfare System. Thesis, Psychology Examination, Sweden: Lund University, Department of Applied Psychology, 8, No 6. Klein M. (1935). A Contribution to the Psychogenesis of Manic-Depressive States. Int. J. Psycho-Anal. 16, 145-174. Klein, M. (1940). Mourning and its Relation to Manic-Depressive States. Int. J. Psycho-Anal. 21, 125-153. Klein, M. (1946). Notes on Some Schizoid Mechanisms. Int. J. Psycho-Anal. 27, 99-110. Kohut, H. (1971). The Analysis of the Self. A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders. New York: International Universities Press. Kohut, H. (1977). The Restoration of the Self. New York: International Universities Press. Kohut, H. (1984). How Does Analysis Cure? Chicago: University of Chicago Press. Kragh, U. (1969). Manual DMT - Defense Mechanism Test. Stockholm: Skandinaviska Testförlaget. Petersson, B. A., Andersson A. L., & Nilsson Å. (1997). Adjustment and Personality Disorders Among Young Adults as Related to Clinical Characteristics and Personality According to SAT and DMTm. (Psykologi i tillämpning, 15, No. 3). Sweden: Lund University, Department of Applied Psychology. Sand, A. (1993). Relations Between Sensitivity to Non-Verbal Communication, Empathy and Mechanisms of Defense. An Explorative Study. Psychological Research Bulletin, Lund University, 33, No 5. Sharma, V. P. S. (1977). Application of A Percept-Genetic Test in A Clinical Setting. Doctoral Thesis, Sweden: Lund University, Department of Psychology. Smith, G. J. W., Johnson, G., & Almgren, P.-E. (1989). MCT – The Meta Contrast Technique. Manual. Stockholm: Psykologiförlaget. Sjöqvist, S. (1996). The Relation Between KAPP and DMTm in Fourteen Psychiatric Patients. Thesis, Psychology Examination, Sweden: Lund University, Department of Applied Psychology, 10, No 13. Sundbom, E. (1992). Borderline Psychopathology and The Defense Mechanism Test. Doctoral Dissertation, Sweden: University of Umeå, Department of Applied Psychology. Westerlundh, B. (1976). Aggression, Anxiety and Defense. Sweden: Lund, Gleerup. World Health Organization. (1987). International Classification of Diseases (9th ed.). Geneva: Author. Defense Mechanism Technique 19

Consistency of Structural Summary Scores in Computerized Rorschach Programs Michael J. Gournaris, Irene W. Leigh and Ross E. Mitchell This study evaluates the consistency of three computerized Rorschach scoring programs. The ratios, percentages, and derivations from 40 Rorschach protocols were derived to evaluate the consistency among these programs. RIAP4™ PLUS and ROR-SCAN© programs have 23 identical Summary Scores (SS) scores (out of 30 scores), the RIAP4™ PLUS vs. Rorschach Profiler© programs have 9 identical SS scores (out of 30 scores), and finally, 9 scores out of 30 SS scores were also found to be identical for both ROR-SCAN© and Rorschach Profiler© programs. The RIAP4™ PLUS and ROR-SCAN© scoring programs were consistently similar in their scoring outputs when compared with each other, while the Rorschach Profiler© appeared to be different in scoring outputs. The potential of the impact on Rorschach interpretations using Exner’s Comprehensive System is also discussed based on the scoring discrepancies identified. An increasing number of psychological assessments are now offered in computerized format (Wetzler, 1990). Given that psychologists tend to trust most commercially available assessment programs (Butcher, 1995), there is a pressing need to evaluate them. This study focuses on computerized Rorschach programs based on Exner’s Comprehensive System (CS). It is important to emphasize that this study is preliminary indicating a serious need for in-depth research evaluating the consistency of Structural Summary (SS) scores in computerized Rorschach programs. This study represents work done at a particular time and with a particular level of inquiry, namely a preliminary investigation using versions of software that have been updated. This does not diminish the fact that computerized Rorschach programs must be subjected to establshing its reliability before they become part of clinical practice. Reliability of Computerized Programs : Burke and Normand (1987) claim that computers have zero error variance, thus producing highly consistent scores, whereas psychologists cannot be as consistent in their scoring of test results (e.g., Barrett et al., 1982; Moreland, 1985; Myers et al., 1983). At the same time, Burke and Normand warn that computers may also produce highly reliable incorrect information if the scores are incorrectly programmed. Purpose of the Study : There is no evidence of comparability across computerized Rorschach programs, which are used to generate Structural Summary scores. The consistency of SS scores in computerized Rorschach programs using client protocols needs to be assessed. This study was guided by two questions: 1. Are the scoring programs across different Rorschach software programs identical or comparatively equivalent? 2. Are there any scoring discrepancies that may affect the Rorschach interpretations on client protocols when using the CS? *Michael J. Gournaris and Irene W. Leigh, Department of Psychology, Gallaudet University, 800 Florida Avenue NE, Washington, DC 20002. Email: mjgournaris@hotmail.com. (*for correspondence) and Ross E. Mitchell, Graduate Research Institute, Gallaudet University. Key Words : Computerized Rorschach Programs.

Method : Rorschach Software Products : Three commercial Rorschach software products were available when this study was conducted, with permission granted by the respective software developers: RIAP4ä PLUS Version 4.50.124, ROR-SCANã V6.02 and Rorschach Profilerã V2.2. Procedure : Forty different Rorschach protocols selected from Exner’s textbooks (1991; 1993; 1995; 2000) and Meloy et al.’s reference book (1997) were collected, covering a variety of clients with different symptoms (e.g., depression/suicidal, psychosis, psychosomatic and obsessive). The client response codes were entered into three different Rorschach programs, each creating a SS of the client’s Rorschach protocol. This study investigates scoring discrepancies in the SS scores calculated by special formulas listed in Exner’s CS textbook. Only 30 out of the more than 60 different SS scores are examined. The others are not reviewed for two reasons: many of them are simple counts that require no special computation formulas; and this investigation is intended to serve as proofof-concept study rather than a full and comprehensive study. The 30 ratios, percentages, and derivations from each client’s SS scores were then entered into a statistical computer program for data analyses. Any discrepancies among the SS scores, indicated by less than perfect correlation between program outputs, were checked to ensure that they were correctly and identically entered for each program. The ratios, percentages, and derivations investigated are as follows: Lambda, EA, es, D, Adj es, Adj D, Afr, GHR, PHR, Isolation Index, 2AB+(Art+Ay), 3r + (2)/R, Sum6, Wsum6, XA%, WDA%, X-%, X+%, Xu%, Zf, Zsum, Zest, Zd, PTI, SCZI, DEPI, CDI, S-CON, HVI, and OBS. The SS scores for all 40 Rorschach protocols entered are compared using Pearson correlations. Three paired tests were performed to determine if there are scoring differences on any of the 30 SS scores between any pair of the Rorschach programs used in this study, which is indicated by any value less than one. Correlations are calculated here because of their sensitivity to differences between pairs, increasingly so for large discrepancies due to the use of squared differences, and not because of any meaning attributable to the means. No differences are expected, since each program is expected to use exact and identical computation formulas for SS scores based on Exner’s (1993, 2001, 2003) work, so any difference should be examined. We note here that the examination of differences does not include inspection of scoring algorithms. This study is limited to investigating the scoring outputs generated, their consistency, and the likelihood that any output differences would lead psychologists to erroneous conclusions. Part One : Results of Statistically Significant Differences RIAP4™ PLUS vs. ROR-SCAN© Out of 30 SS scores, the RIAP4™ PLUS and ROR-SCAN© programs have 23 identical scores. The minuscule differences for the remaining seven SS scores (Lambda, GHR, PHR, XA%, X-%, X+%, Xu%) can be ignored. However, the relatively larger differences (by only one point) for the Xu% scale were investigated. Out of the 40 protocols, the differences in this particular SS score show that only four client protocols for both Consistency in Computerized Rorschach Programs 21

programs generate different scores, resulting in no difference for clinical interpretation according to the CS. This comports well with the finding that all 30 SS scores for these programs have near perfect correlations (between .996 to 1.000, p = .000). RIAP4™ PLUS vs. Rorschach Profiler© Out of the 30 SS scores, the Rorschach Profiler© showed 21 scores that differed from the RIAP4™ PLUS, while nine SS scores were identical. Fourteen SS score differences are ignorable. Seven scales have clinically significant differences; they are: the PTI, SCZI, GHR Lambda, XA%, WDA%, and PHR scales. These seven differed for one or more client protocols according to the CS (discussed in Part Two of the Results section below). The paired samples correlations between the RIAP4™ PLUS and the Rorschach Profiler© programs are high, but not as high as the previous comparison between the RIAP4™ PLUS and ROR-SCAN© programs (ranging from .858 to 1.000, p = .000). ROR-SCAN© vs. Rorschach Profiler© Given the near-perfect correlations between the RIAP4™ PLUS and ROR-SCAN© programs, the results for the comparison between ROR-SCAN© and Rorschach Profiler© programs are very comparable to those presented above. Twenty-one scores out of 30 SS scores differ for both ROR-SCAN© and Rorschach Profiler© programs while nine SS scores are identical. The same seven scales have clinically significant differences for one or more protocols, and the range of correlations is the same as well (ranging between .858 and 1.00, p = .000). Again, this indicates problems with the consistency of the Rorschach Profiler© calculations for SS scores relative to the other two programs. The next section focuses on how scoring discrepancies may affect the Rorschach interpretations of client protocols when using the CS. Part Two: Results of Clinically Significant Differences Results indicate that the RIAP4™ PLUS and ROR-SCAN© scoring programs are consistently similar in their scoring outputs, while the Rorschach Profiler© appears to differ. When scrutinizing the scoring differences generated by the three programs for the same client protocol, clinically significant numerical differences across scoring programs are observed. That is, based on the scoring outputs, psychologists may arrive at different conclusions about the same client’s personality based on the CS. For example, using two client protocols (derived from Exner, 1991, p. 351 & Exner, 1993, p. 570), RIAP4™ PLUS and ROR-SCAN© have exactly the same SCZI scores of 5 (clinically significant), whereas the Rorschach Profiler© scored the same protocol with a score of 2 (not clinically significant). In all, 17 SS scores in seven respective interpretive scales (e.g., ratios, derivations, or indices) would generate different clinical interpretations according to the CS. The remaining 15 instances of scoring differences found across several client protocols are now presented. For the Rorschach Profiler©, two different protocols, hereafter referred to as Protocol A and Protocol B2, generated clinically significant scores on the Perceptual Thinking Index (PTI) when entered in the Rorschach Profiler© because the program developer used the scoring cut-off of 3 instead of the recommended 4 (Exner, 22 Gournaris et.al.

2003). The RIAP4™ PLUS and ROR-SCAN© did not produce clinically significant scores for the same PTI scores because they follow the cut-off score of 4 suggested by Exner (2003). The impact of the lower cut-off scores on the Rorschach Profiler© is evident on the Suicide Constellation Index (S-CON), for which the Rorschach Profiler© generated a clinically significant score of 8 for Protocol A (derived from Exner, 1991, p. 265) while the other two programs did not, although their scores (both 7) were elevated. In another example, the Rorschach Profiler© produced an elevated Lambda score of 0.33 for one particular client’s profile, Protocol C (derived from Exner, 1991, p. 390), which would warrant a different clinical interpretation based on the Lambda scoring cut-offs as indicated in the CS, whereas the RIAP4™ PLUS and ROR-SCAN© programs resulted in lower and identical Lambda scores of 0.25. The Rorschach Profiler© also generated lower scores for both XA% and WDA% scales (0.82 and 0.81, respectively), both of which are new and work conjointly in determining aspects related to personality (Exner, 2001; 2003), when compared with the RIAP4™ PLUS and ROR-SCAN© programs (0.88 for both) on one client protocol, Protocol D, (derived from Meloy et al., p. 497). Based on the CS scoring ranges, there will be a slight difference in interpreting any one client’s personality when using these interpretive scales. Lastly, the GHR and PHR scales, which are also new to the CS (Viglione et al., 2003), work conjointly in describing one’s relationship style with others. For these scales, the RIAP4™ PLUS and ROR-SCAN© differ from the Rorschach Profiler© on seven different client protocols, labeled Protocol E through Protocol K3 (out of 40). All of the seven Rorschach Profiler©’s scores have the potential for different clinical interpretations compared to the other two programs (see Table I). For example, the first two programs’ GHR scores were larger than the PHR scores, which indicate that the client appears to have good overall relationships with others, whereas the Rorschach Profiler© generated larger PHR scores for the same client protocol, thus generating a different clinical interpretation for the same client (i.e., poor overall relationships with others). Across all three computerized Rorschach programs, the GHR and PHR scores have the largest repeated numerical differences compared to all other interpretive scales. Discussion : All of the computerized Rorschach scoring programs available for this study did not produce numerically or clinically consistent score reports for all 30 SS scores examined here. However, before making too much of the preliminary study, we must note that newer versions have replaced all programs investigated in this study. The Psychological Assessment Resources, Inc. has recently upgraded their program to RIAP5™, the ROR-SCAN© is now at version 6.03, and the Rorschach Profilerã is upgraded to version 2.4, We have not determined whether or not the discrepancies associated with older versions would remain present in the newer versions. Nonetheless, the findings in this study document the need for careful analysis of consistency in scoring across programs. Though newer versions are currently on the market, the need for a comprehensive evaluation remains unmet. Consistency in Computerized Rorschach Programs 23

Table 1 Possible Different Clinical Interpretations on the GHR:PHR Ratio Response Differences Identified across the Computerized Rorschach Scoring Programs Variables RIAP4™ PLUS ROR-SCAN© Ror-Profiler© GHR:PHR scores for Protocol E 4:4 4:4 3:4* GHR:PHR scores for Protocol F 5:5 5:5 6:3* GHR:PHR scores for Protocol G 4:6 4:6 4:3* GHR:PHR scores for Protocol H 2:1 2:1 0:3* GHR:PHR scores for Protocol I 4:5 4:5 4:4* GHR:PHR scores for Protocol J 5:2 6:1 1:4* GHR:PHR scores for Protocol K 3:1 3:1 2:2* *Would generate different clinical interpretations according to the Comprehensive System Based on this study’s findings, it would be advisable for all program developers to evaluate their programming accuracy, especially for both GHR and PHR scores. Without knowledge of the exact algorithms used, only speculation as to the reasons for the differences can be offered. Both scores are new to the CS and the criteria in assigning GHR or PHR designations to clients’ human representational responses (Exner, 2003, p. 144, Table 9.1), are both comprehensive and complex, which may mean that the multi-step logic (total of seven steps) are not reliably reproduced. Several speculative possibilities may explain the numerical differences found in the ratios, percentages, and derivations when compared across programs. First, there are possibilities related to algorithm differences. The most severe would be that the algorithms are fundamentally different; the formula for calculating a particular ratio or derivation is not identical for each program, which could easily lead to numerically different results, particularly as noted for the GHR and PHR. Much less likely are numerical precision errors due to rounding or other propagations of error, and differences in developer and user computer specifications. Such possibilities were not investigated here. The preliminary results strongly suggest that it is unwise to proceed with the use of computerized Rorschach programs without additional research on the reliability of these programs. This study has uncovered enough discrepancies to assert that it is not possible to use these programs with a high level of confidence in their ability to produce reliable scoring outputs. In addition, the program versions used in this study may still be in use; also as some psychologists may not have chosen to upgrade their software. Further, incorrect conclusions may have been drawn based upon the faulty assessments in the scoring outputs. Limitations of the Study : In interpreting the present results, the limitations in the analyses of this study firstly include comparison of only 30 different SS scores (ratios, percentages, and derivations) 24 Gournaris et.al.

and evaluating only the scoring discrepancies in the SS scores that were calculated by special formulas listed in Exner’s CS. Second, only known client protocols were used to test the reliability of the scoring algorithms for each of the three computer programs. Third, there was no direct examination of the scoring algorithms used by the programs to identify precisely what factors, other than differences in cut-off values, were responsible for the divergent scores, whether clinically significant or not. Finally, this study does not attempt to find out if scoring discrepancies in the SS scores would generate different clinical interpretations in the interpretive narratives generated by the three computerized Rorschach programs although some examples provided here suggest that such discrepancies may occur. Recommendations : Whether the scoring discrepancies in the SS scores actually have a significant impact on the interpretive narratives entails a process requiring fully detailed computer algorithms which were not available to identify the Rorschach program developers’ scoring cut-offs for their clinical interpretations. No experimentation using simulated protocols was performed, but this should be done to consider the variety of client response possibilities not represented in the protocols used for this study. In order to fully evaluate whether or not the scoring discrepancies have an impact on the interpretive narratives, each of the program’s decision trees in the computer algorithms needs to be reviewed to determine the developers’ scoring cut-offs for interpretations. An interested researcher with extensive experience in computer programming should undertake this type of study. References : Barrett, G. V., Alexander, R. A., Doverspike, D., Cellar, D., & Thomas, J. C. (1982). The Development and Application of a Computerized Information Processing Test Battery. Applied Psychological Measurement, 6, 13-29. Burke, M. J. & Normand, J. (1987). Computerized Psychological Testing: Overview and Critique. Professional Psychology: Research and Practice, 18(1), 42-51. Butcher, J. N. (1995). How to use Computer-Based Reports. In J. N. Butcher (Ed.), Clinical Personality Assessment: Practical Approaches (pp. 78-94). New York, NY: Oxford University Press. Exner, J. E. (1991). The Rorschach: A Comprehensive System. Volume 2: Interpretation (2nd Ed.). New York, NY: Wiley. Exner, J. E. (1993). The Rorschach: A Comprehensive System. Volume 1: Basic Foundations (3rd Ed.). New York, NY: Wiley. Exner, J. E. (1995). A Rorschach Workbook for the Comprehensive System, 4th Edition. Asheville, NC: Rorschach Workshops, Inc. Exner, J. E. (2000). A Primer for Rorschach Interpretation Rorschach Workshops. Ashville, NC: Rorschach Workshops, Inc. Exner, J. E. (2001). A Rorschach Workbook for the Comprehensive System, 5th Edition. Asheville, NC: Rorschach Workshops, Inc. Exner, J. E. (2003). The Rorschach: A Comprehensive System. Volume 1: Basic Foundations (4th Ed.). New York, NY: Wiley. Consistency in Computerized Rorschach Programs 25

Meloy, J. R., Acklin, M. W., Gacono, C. B., Murray, J. F., & Peterson, C. A. (1997). (Eds.)., Contemporary Rorschach interpretation. Mahwah, NJ: Lawrence Erlbaum Associates. Moreland, K. L. (1985). Validation of Computer-Based test Interpretations: Problems and Prospects. Journal of Consulting and Clinical Psychology, 53, 816-825. Myers, D.C., Schemmer, F. M., & Fleshimann, E. A. (1983). Analysis of Computer Interactive Tests for Assigning Helicopter Pilots to Different Mission (Research Report R-83-8). Bethesda, MD: Advanced Research Resources Organization. Viglione, D. J., Perry, W., Jansak, D., Meyer, G., & Exner, J. E. (2003). Modifying the Rorschach Human Experience Variable to Create the Human Representational Variable. Journal of Personality Assessment, 81(1), 64-73. Wetzler, S. (1990). Computerized Psychological Assessment. In D. Baskin (Ed.)., Computer Applications in Psychiatry and Psychology, (pp. 43-56). New York, NY: Brunner/Mazel. End Notes : 1 Permission was obtained from the publishers to use these protocols in this study. 2 Protocols derived from Exner, 1991, p. 265; Exner 1995, p. 292. 3 Protocols derived from Exner, 1991, p. 239, 284, 351, 454; Exner, 1993, p. 604 & 620; Exner 1995, p. 299. Author Note : This project was supported by the Gallaudet Research Institute Small Grants program and the Paul J. Ferraro Memorial Grant. 26 Gournaris et.al.

Impact of Number of Responses on the Interpretation of Rorschach Indices Bankey L. Dubey, Wilfred A.Cassell and Anand Dubey Two hundred psychiatric patients admitted in a military hospital and one hundred normal subjects in the age range of 20-40 years, all males were administered the Rorschach test. A number for scoring indices of Rorschach protocol is said to be dependent on the number of responses given by the subjects. Therefore, a procedure for controlling the protocol for the productivity was warranted. Accordingly, all the 300 protocols were divided on the basis of their number of responses into two groups taking the combined median as the cut-off point. The above median group is called “High Productivity Group (HPG)” and below median group as “Low Productivity Group (LPG)”. Each of these groups was separately analyzed by chi-square test for each of the Rorschach indices. The mean values for the profiles of normal, schizophrenia and neurosis were calculated for various indices separately for HPG and LPG groups to facilitate comparison with other studies. Among the 31 variables found significant with out controlling for the productivity, only 25 remained significant when analyzed after controlling for the productivity (Number of R). The 6 variables which turned to be not significant were Dd, FK, Fc, C’ (H) and Ad. These 6 variables were quite insignificant for both the groups: HPG and LPG. In addition to these, W, K, C, Ad, Sex, Obj, Cloud and Blood did not turn out to be significant in LPG in differentiating the three groups. In the HPG, two variables i.e. R achromatic and “At” lost their significance. The variables, which did not show any change in their level of significance, were Rt chromatic A, P and F+%. Thus, it may indicate a need for further study of these variables after controlling precisely for the number of responses (Total R). The Rorschach test grew out of clinical instigations and is still primarily a method of individual diagnosis. The Rorschach test, though, departs in many ways from usual test methodology, the statistical methods have been conventionally employed in analysing the Rorschach responses. However, such statistical analyses have largely overlooked the variations in the total number of responses. In the Rorschach test, productivity usually varies (when administered following any of the traditional method) because the subject is free to give as many responses as he/she likes. Various Rorschach indices on Location, Determinants and Contents are thus, likely to co-vary with variations in overall productivity and therefore would be related with it. As early as 1949, Cronbach has warned about the uses and abuses of statistical designing in Rorschach. In an interesting and illuminating paper, Fiske and Baughman (1953) have tried to see the correlation between R and various Rorschach indices. They concluded that though R is related with a variety of Rorschach Indices, yet the exact nature of relationship and its psychological significance is not properly Bankey L. Dubey, Ph.D., DPM, FSIS Professor of Psychology and Director SIS Centre P.O. Box 1107, Sector 15 Post Office Chandigarh-160015 (India) Email : sisdubey@rediffmail.com, Wilfred A. Cassell, M.D., FAPA,APC Director SIS Center, 4501 East, 104th Avenue, Anchorage- 99516(USA) Email:siscassell@yahoo.com. and Anand Dubey, Editor SIS Journal, 4406 Forest Road, Anchorage, AK 99517 (USA) E-Mail: adubey@hotmail.com. Key Words : Number of responses and Rorschach

understood. In an edited book, Goldfried, Stricker and Weiner (1971) have also emphasized this point. One of the authors (B.L.D) personally enquired with various experts such as, H.S. Asthana (Saugar), H.N. Murthy (Banglore), Samuel J. Beck (Chicago), Helen H. Davidson (New York), H.J. Eysenck (London), Marguerite R. Hertz (Cleveland, Ohio), Albert I. Rabin (Michigan), Max R. Reed (Portland), and Norman D. Sundberg (Eugene, Oregon) about weighting the raw frequencies of Rorschach indices with overall productivity. In response to this personal enquiry made in 1977, all the experts pointed out that it would certainly be vital to take into account the number of responses while analyzing the Rorschach data. In most of the studies reported from India and abroad, the number of responses has not been considered while analyzing the data. To make the point clear, if subjects in two diagnostic categories give significantly different R (total number of response), this difference would also be reflected in other Rorschach indices and thus, the result will not be correct (see Meehl, 1957). For example, in Kumar’s (1959) study the mean number of responses was 22.10 for normal and 24.46 for neurotics. These two groups were found to be significantly different on only a few variables whereas the normal group was found to be significantly different on all the variables when compared with the schizophrenic group. The mean number of responses in this group was 13.96. Surprisingly, the group of paranoid schizophrenia (Mean R=21.63) differed only on a few variables. Thus, the differences obtained by means of usual statistical design might have been observed because of differences in productivity alone. Such observations extend the hypothesis that observed differences between normal and various psychopathological groups on some Rorschach indices may be the artifacts of the differences in the productivity (i.e. the total number of responses). Another methodological problem associated with the use of statistical analysis on Rorschach responses is the variation in the shape of the distribution of scores on various Rorschach indices. Many of the significant Rorschach indices yield sharply skewed distributions for different types of populations (Beck, 1938; Hertz, 1942; Rapaport, 1946 etc). Skewness is usually found on those indices on which a number of subjects earn either zero, 1 or 2 points. Moreover, there is no way of demonstrating equality of units unless one has some knowledge of the true distribution of the trait scores. This is, though the problem with all psychological tools yet other tests yield normal distributions that are assumed to represent the true spread of ability (Cronbach, 1949). Unlike procedures involving the addition of scores, procedures based on counting of frequencies make no assumption about the scale units (Siegel. 1959 Maxwell, 1971). Cronbach (1949) mentions, “infact they give the same results no matter how the scale units are stretched or regrouped. The median, or the number of cases falling beyond some critical point, depends only on the order of score”. Thus, statistical procedures based on counting are much more suitable than others for Rorschach variables. There is obviously more advantage in using a procedure that leads to a single invariant result independent of the assumption about the equivalence of scores. Cronbach emphasize that even if scores are normalized the median may be used to indicate central tendency and the chi-square to test the significance of difference of Rorschach scores. For the use of chi-square, a cut-off point should invariably be specified beforehand, to avoid bias and confusion. Many statisticians and researchers have set arbitrary rules for this 28 Dubey et.al.

purpose (Cronbach, 1949; Siegel, 1959; Maxwell, 1971; Kumar, 1974). The most frequently used rule is cutting the scores as nearer its median as possible. Considering the above-mentioned methodological (statistical) issues, the present study attempts to examine the effect of total number of responses on the observed diagnostic efficacy of various Rorschach indices. It tries to examine how and to what extent the overall productivity on the Rorschach influences the scores on various Rorschach indices. Attempt has also been made to study whether or not the difference between the group on various Rorschach indices disappear after controlling for the productivity (total number of responses). In addition to these, attempt has also been made to develop the Rorschach profiles of high and low productive normal, schizophrenic and neurotic groups. Material and Method : To achieve the aims, two hundred psychiatric patients admitted in a military hospital and one hundred normal (non-clinical) participants were recruited for the present study. The selection of the patients were based on the following inclusion criteria: a) Male psychiatric patients admitted in the ward and cooperative enough for testing. b) Age range between 20-40 years. c) Educated at least unto 6th class but not more than 10th. d) Having first episode of metal illness. e) Where two psychiatrists agreed with regard to the diagnosis (based on International Classification of Diseases) f) Only those patients diagnosed as suffering from schizophrenia or neurosis (one hundred each). g) One hundred ‘normal’ subjects matched for age, sex and education from the attendants of the patients. Rorschach inkblot test was administered individually on each participant following the method of Klopfer et al. (1954). The test was administered within the first week of admission or as soon as the patient became amenable for psychological testing but not later than two weeks after admission. The test was always administered before the patients received any active psychiatric treatment. The normal subjects were also administered Rorschach test individually. Differences among the three groups (two clinical and one control) with regard to various Rorschach indices were evaluated with the help of chi-square test of significance. Further, to control the productivity on Rorschach protocols, each group was divided into two subgroups based on the total number of responses (cutoff point being the combined median). The above median and the below median groups were separately analyzed for the significance of various Rorschach indices. Only those variables were treated which were found significant. Profiles of normal, schizophrenic and neurotic groups were prepared for above median and below median groups separately. Statistical Procedure : Non-parametric statistics is the only available choice for the analysis of Rorschach indices. Thus, the chi-Squire test of significance was used to find whether the three groups of subjects could be differentiated on each of the Rorschach variables, separately. Impact of Number of Responses on Rorschach 29

A number for scoring indices of Rorschach protocol is said to be dependent on the number of responses given by the subjects. Therefore, a procedure for controlling the protocol for the productivity was warranted. According to the method of Klopfer et. al. (1954), the subject is free to give as many responses as he likes. Therefore, a statistical design validated by Dubey and Pershad (1978a, 1978b) for controlling the productivity was used. Accordingly, all the 300 protocols were divided on the basis of their number of responses into two group taking the combined median as the cut-off point. The above median group is called hereafter “High Productivity Group (HPG)” and below median group as “Low Productivity Group (LPG)”. Each of these groups were separately analyzed by chi-square test for each of the Rorschach indices by making 3x2 contingency tables (3 groups, each divided into two, the cut-off point being the combined median). The mean values for the profiles of normals, schizophrenics and neurotics were calculated for various indices separately for HPG and LPG groups to facilitate comparison with other studies where means have been calculated. For the sake of convenience, only those variables that remained significant even after controlling for productivity will be called hereafter first analysis variables” while those found significant only in HPG or in LPG group will be called “second analysis variables”. Results : Mean and range of the three groups of subjects (Normal, Neurosis and Schizophrenia) before and after controlling the productivity in two groups (high productivity group HPG and low productivity group LPG) are shown in tables 1,2 and 3. The Rorschach test grew out of clinical instigations and is still primarily a method of individual diagnosis. The statistical methods employed however, have been conventional, even though Rorschach test departs in may ways from test’s methodology. In the Rorschach test, productivity usually varies (when administered following any of the traditional method) because the subject is free to give as many responses as he likes. Various indices on Location, Determinants and Contents would thus be related with it. As early as 1949, Cronbach has warned about the uses and abuses of statistical designing in Rorschach. In an interesting and illuminating paper Fiske and Baughman (1953) have tried to see the correlation between R and various Rorschach indices. They concluded that though R is related with other Rorschach Indices, yet the exact nature of relationship and its psychological significance is not properly understood. In and edited book, Goldfried, Stricker and Weiner (1971) have also emphasized this point. In response to a personal enquiry by one of the authors (B.L.D.) in 1977, H.S. Asthana (Saugar) H.N. Murthy (Banglore) Samuel J. Beck (Chicago) Helen H. Davidson (New York) H.J. Eysenck (London) Marguerite R. Hertz (Cleveland, Ohio) Albert I. Rabin (Michigan), Max R. Reed (Portland) and Norman D. Sundberg (Eugene, Oregon) have pointed out that it is certainly very vital to take into account the number of responses while analyzing Rorschach data. In most of the reported studies from India and abroad, the number of responses has not been considered while analyzing the data. To make the point clear, if subjects in two diagnostic categories give significantly different R (total number of response), this 30 Dubey et.al.

difference would also be reflected in other Rorschach indices and thus, the result will not be correct (see Meehl, 1957). For example, in Kumar’s (1959) study the mean number of responses was 22.10 for normal and 24.46 for neurotics. These two groups were found to be significantly different only on a few variables whereas the normal group was found to be significantly different on all the variables when compared with the schizophrenic group. The mean number of responses in this group was 13.96. Surprisingly, the group of paranoid schizophrenia (Mean R=21.63) differed only on a few variables. Thus, the differences arrived at through the use of usual statistical design might have been because of differences in productivity alone. Many of the significant Rorschach scores give sharply skewed distributions for most populations (Beck, 1938; Hertz, 1942; Rapaport, 1946 etc). Skewness is usefully found where many subjects earn zero, 1 or 2 points. There is no way of demonstrating equality of units unless one has some knowledge of the true distribution of the trait scores. Though, this is a problem of all the psychological tools yet other tests yield normal distributions which are assumed to represent the true spread of ability (Cronbach, 1949). Unlike procedures involving the addition of scores, procedures based on counting of frequencies make no assumption above the scale units (Siegel. 1959 Maxwell, 1971). Cronbach (1949) mentions, “infact they give the same results no matter how the scale units are stretched or regrouped. The median, or the number of cases falling beyond some critical point, depends only on the order of score”. Thus statistical procedure based on counting are much more suitable than others for Rorschach variables. There is obviously much merit in using a procedure which leads to a single invariant result, independent of the assemption of the investigator about the equivalence of scores. Cronbach emphasizes that even if scores are normalized the median be used to indicate central tendency and chi-square to test the significance of difference of Rorschach score. For the use of chi-square, a cut-off point should invariably be specified beforehand, to avoid bias and confusion. Many statisticians and researchers have set arbitrary rules for this purpose (Cronbach, 1949; Siegel, 1959; Maxwell, 1971; Kumar, 1974). The most frequently used rule is cutting the scores as nearer its median as possible. Material and Method : To achieve the aims, two hundred psychiatric patients admitted in a military hospital and one hundred normal fulfilling the following criteria were taken for the study: a) Male psychiatric patients admitted in the ward and cooperative enough for testing. b) Age range between 20-40 years. c) Educated at least unto 6th class but not more than 10th. d) Having first episode of metal illness. e) Where two psychiatrists agreed with regard to the diagnosis (based on International Classification of Diseases) f) Only those patients diagnosed as suffering from schizophrenia and neurosis (one hundred each). Impact of Number of Responses on Rorschach 31

g) One hundred ‘normal’ subjects controlled for age, sex and education from the attendants of the patients. The cases were administered the Rorschach inkblot test following the method of Klopfer et al. (1954). The test was administered within the first week of admission or as soon as the patient became amenable for psychological testing but not later than two weeks after admission. The test was always administered before the patients received any active psychiatric treatment. The normal subjects were also administered Rorschach test individually. Differences among the three groups (two clinical and one control) with regard to various Rorschach indices were evaluated with the help of chi-square test of significance. Further, to control the productivity on Rorschach protocols, each group was divided into two categories on the basis of its number of responses (cutoff point being the combined median). The above median and the below median groups were separately analyzed for the significance of various Rorschach indices. Only those variables were treated which were found significant. Profiles of normal, schizophrenic and neurotic groups were prepared for above median and below median groups separately. Statistical Procedure : Non-parametric statistics is the only available choice for the analysis of Rorschach indices. Thus the chi-Squire test of significance was used to find whether the three group of subjects could be differentiated for each of the Rorschach variables, separately. A number for scoring indices of Rorschach protocol is said to be dependent on the number of responses given by the subjects. Therefore, a procedure for controlling the protocol for the productivity was warranted. According to the method of Klopfer et. al. (1954), the subject is free to give as many responses as he likes. Therefore, a statistical design validated by Dubey and Pershad (1978a, 1978b) for controlling the productivity was used. Accordingly, all the 300 protocols were divided on the basis of their number of responses into two groups taking the combined median as the cut-off point. The above median group is called hereafter “High Productivity Group (HPG)” and below median group as “Low Productivity Group (LPG)”. Each of these groups was separately analyzed by chi-square test for each of the Rorschach indices by making 3x2 contingency tables (3 groups, each divided into two, the cut-off point being the combined median). The mean values for the profiles of normal, schizophrenia and neurosis were calculated for various indices separately for HPG and LPG groups to facilitate comparison with other studies where means have been calculated. For the sake of convenience, only those variables that remained significant even after controlling for productivity will be called hereafter first analysis variables” while those found significant only in HPG are in LPG group will be called “second analysis variables”. Results : Mean and range of the three groups of subjects (Normal, Neurosis and Schizophrenia) before and after controlling the productivity in two groups (high productivity group HPG and low productivity group LPG) are shown in tables 1,2 and 3. 32 Dubey et.al.

Impact of Number of Responses on Rorschach 33 Table 1 Mean Value and Ranges of Rorschach Indices in Normal Subjects HPG (N=75 LPG (N=25 Total (N=100) Variable Mean Range Mean Range Mean Range R 14.79 6-112 10.68 10-11 13.76 3-15 R (Ach) 5.97 4-11 5.16 4-7 5.77 1-22 R( Ch) 8.82 6-17 5.52 4-7 7.99 2-48 Rt in Sec. 21.81 8-39 27.72 11-41 23.29 7-44 Rt (Ach) 22.41 6-73 27.92 11-45 23.29 8-78 Rt (Ch) 21.07 6-42 27.52 11-46 22.68 8-03 W 4.15 1-7 4.00 3-6 4.11 1-33 DW - - - - - - D 9.96 5-19 6.56 4-8 9.11 3-24 d 0.48 0-3 0.04 0-1 0.37 0-83 Dd 0.04 0-1 - - 0.03 0-17 S 0.16 0-1 0.08 0-1 0.14 0-37 F 4.83 0-12 2.84 0-6 4.33 2-49 M 1.45 0-4 1.00 0-3 1.34 0-76 FM 5.35 2-10 5.04 3-8 5.27 1-74 m 0.36 0-2 0.24 0-1 0.33 0-53 K - - - - - - FK 0.36 0-3 0.20 0-2 0.32 0-61 k 0.08 0-2 - - 0.06 0-31 Fc 0.52 0-4 0.52 0-3 0.52 0-93 C’ 0.59 0-2 0.24 0-1 0.50 0-64 FC 0.67 0-3 0.28 0-1 0.57 0-75 CF 0.40 0-4 0.16 0-2 0.34 0-69 C 0.19 0-1 0.16 0-2 0.18 0-48 H 1.43 0-3 1.04 0-3 1.33 0-66 Hd 0.64 0-4 0.32 0-1 0.56 0-83 (H) 0.04 0-1 - - 0.03 0-17 A 7.63 4-13 7.16 4-10 7.51 2-31 Ad 0.60 0-3 0.36 0-2 0.54 0-68 A obj 0.41 0-3 0.36 0-1 0.40 0-58 At 0.75 0-5 0.12 0-1 0.59 0-99 Sex 0.35 0-4 0.32 0-2 0.34 0-74 Obj 0.67 0-3 0.28 0-2 0.57 0-80 PI 0.96 0-5 0.28 0-3 0.79 1-04 N 0.39 0-4 0.08 0-2 0.31 0-78 Geog. 0.08 0-1 - - 0.06 0-27 Art 0.08 0-2 0.08 0-1 0.08 0-34 Arch 0.21 0-2 0.08 0-1 0.18 0-48 Cloud 0.16 0-1 0.08 0-1 0.14 0-35 Blood 0.19 0-1 0.08 0-1 0.16 0-39 Fire 0.04 0-1 - - 0.03 0-17 Misc 0.17 0-1 0.04 0-1 0.14 0-37 P (Klopfer) 4.85 2-7 4.76 3-6 4.83 0-99 P (Asthana) 6.68 2-1 6.12 4.8 6.54 1-58 F+ % 75.90 48.100 88.10 55-100 79.00 13-70 F % 32.65 26.59 31.46 A% 55.64 70.41 58.50 Sum C% 1.35 0.54 0.89 of R card no. VII + IX+X 37.13 31.56 35.74

Table 2 Mean Value and Ranges of Rorschach Indices in Schizophrenia HPG (N=75 LPG (N=25 Total (N=100) Variable Mean Range Mean Range Mean Range R 15.74 12-24 9.30 5-11 12.71 4-42 R (Ach) 6.39 4-13 4.60 2-6 5.55 1-59 R( Ch) 9.36 5-17 4.70 1-6 7.17 3-24 Rt in Sec. 14.78 7-43 14.04 6-27 14.43 5-34 Rt (Ach) 14.90 6-39 13.37 5-24 14.18 5-63 Rt (Ch) 14.66 7-25 14.58 6-27 14.62 5-98 W 4.59 1-12 4.77 0-10 4.67 2-58 DW 0.49 0-2 0.38 0-2 0.44 0-84 D 8.81 2-19 3.21 0-10 6.18 4-49 d 1.36 0-6 0.75 0-5 1.07 1-47 Dd 0.17 0-2 0.13 0-2 0.15 0-43 S 0.32 0-3 0.06 0-2 0.20 0-39 F 6.85 0-16 4.79 0-10 5.88 3-39 M 1.41 0-8 0.68 0-0.8 1.07 1-62 FM 2.96 1-9 1.53 0-06 2.29 1-89 m 0.47 0-3 0.23 0-03 0.36 0-71 K 0.15 0-4 0.10 0-03 0.13 0-54 FK 0.21 0-3 0.09 0-02 0.15 0-48 k 0.38 0-7 0.17 0-06 0.28 1-28 Fc 0.59 0-3 0.34 0-04 0.47 0-88 C’ 0.38 0-4 0.28 0-03 0.33 0-91 FC 0.45 0-3 0.40 0-04 0.43 0-82 CF 0.90 0-5 0.30 0-03 0.62 1-01 C 0.98 0-4 0.38 0-04 0.70 1-11 H 1.53 0-8 0.43 0-05 1.01 1-56 Hd 0.92 0-8 0.53 0-05 0.72 1-41 (H) 0.19 0-2 0.36 0-10 0.27 1-10 A 5.72 1-13 3.06 0-10 4.47 3-06 Ad 0.57 0-7 0.23 0-02 0.41 1-01 A obj 0.26 0-4 0.21 0-03 0.24 0-07 At 1.13 0-9 1.62 0-10 1.36 2.39 Sex 2.00 0-8 1.47 0-09 1.75 2-67 Obj 0.57 0-4 1.21 0-02 0.40 0-83 PI 0.62 0-5 1.28 0-03 0.46 1-18 Nat 0.45 0-6 0.21 0-04 0.34 1-10 Geog 0.17 0-7 0.04 0-02 0.11 0-84 Art 0.15 0-2 0.08 0-04 0.12 0-58 Arch 0.23 0-2 0.08 0-01 0.16 0-48 Cloud 0.24 0-6 0.11 0-02 0.18 0-77 Blood 0.77 0-5 0.21 0-02 0.51 0-99 Fire 0.06 0-2 0.06 0-03 0.06 0-39 Misc. 0.15 0-2 0.13 0-02 0.14 0.50 P (Klopfer) 2.75 0-6 1.66 0-04 2.24 1.39 P (Asthana) 3.74 0-8 1.94 0-04 2.89 1.83 F+ % 35.60 8.71 28.10 0-71 32.10 18.20 F % 43.52 51.50 46.26 A% 39.96 35.38 38.39 Sum C 2.59 1.07 1.88 % of R card 34.68 29.70 32.34 no. VII + IX+X 34 Dubey et.al.

Table 3 Mean Value and Ranges of Rorschach Indices in Neurosis HPG (N=75 LPG (N=25 Total (N=100) Variable Mean Range Mean Range Mean Range R 13.10 12-7 9.92 6-11 11.22 1-98 R (Ach) 5.61 4-7 4.66 2-6 5.05 0-97 R( Ch) 7.49 6-10 5.26 3-8 6.19 1-48 Rt in Sec. 29.43 11-64 39.66 13-70 35.45 14-83 Rt (Ach) 29.80 11-68 41.59 14-64 36.75 17-00 Rt (Ch) 28.79 11-60 37.61 12-65 33.99 13-18 W 4.76 1-9 4.20 1-09 4.43 1-88 DW - - - - - - D 7.91 3-12 5.41 2-10 6.43 2-21 d 0.29 0-3 0.15 0-02 0.21 0-52 Dd 0.02 0-1 0.02 0-01 0.02 0-14 S 0.13 0-2 0.14 0-02 0.13 0-39 F 4.46 0-11 4.42 0-10 4.34 2-53 M 0.66 0-02 0.54 0-02 0.59 0-62 FM 3.39 0-07 1.78 0-05 2.44 1-68 m 0.39 0-03 0.31 0-01 0.34 0-59 K 0.54 0-03 0.24 0-02 0.36 0-75 FK 0.34 0-04 0.25 0-02 0.29 0-86 k 0.22 0-02 0.12 0-01 0.16 0-46 Fc 0.32 0-01 0.85 0-03 0.63 0-60 C’ 0.66 0-04 0.29 0-02 0.44 0-79 FC 0.56 0-03 0.36 0.02 0.44 0-68 CF 0.64 0-04 0.41 0-03 0.50 0-78 C 0.93 0.04 0.53 0-04 0.69 1-04 H 0.83 0-03 0.66 0-02 0.73 0-63 Hd 0.32 0-02 0.37 0-03 0.35 0-65 (H) 0.02 0-01 0.02 0-01 0.02 0-14 A 5.07 0-11 4.12 0-08 4.51 2-22 Ad 0.37 0-03 0.37 0-03 0.37 0-64 A obj 0.39 0-02 0.34 0-02 0.36 0-61 At 1.54 0-10 1.53 0-10 1.53 2-23 Sex 0.51 0-04 0.49 0-03 0.50 1-00 Obj 0.37 0-05 0.22 0-02 0.28 0-71 PI 0.68 0-05 0.37 0-02 0.50 0-81 Nat 0.73 0-06 0.44 0-03 0.56 1-11 Geog. 0.17 0-02 0.02 0-01 0.08 0-34 Art 0.15 0-01 0.12 0-01 0.13 0-36 Arch. .020 0-03 0.07 0-01 0.12 0-41 Cloud 0.83 0-03 0.24 0-02 0.48 0-74 Blood 0.80 0-04 0.41 0-03 0.57 0-93 Fire 0.02 0-01 0.02 0-01 0.02 0-14 Misc. 0.10 0-01 0.12 0-02 0.11 0-34 P (Klopfer) 3.93 0-07 3.63 0-06 3.75 1-39 P (Asthana) 5.22 0-08 4.82 0-09 4.98 1-84 F+ % 56.90 0-100 65.80 9-100 62.20 22-26 F % 34.05 44.56 38.68 A% 41.52 45.26 43.49 Sum C 2.31 1.38 1.75 % of R on card no. VII + IX+X 32.66 32.32 32.46 The over all picture of level of significance of Rorschach indices in three groups of subjects are shown in Table 4 suggests that many indices which were found significant, turned to be non significant particularly in LPG group often controlling for the productivity Impact of Number of Responses on Rorschach 35

Table 4 Over All Picture of Level of Significance of Rorschach in the Three Groups of Subjects Variable Control Schizo- Control Neurosis Schizo Neurosis Vs vs Vs VS Vs Vs (HPG) (LPG) (HPG) (LPG) (HPG) (LPG) R ns .01 .01 .01 .01 ns R (Ach) ns .01 ns .02 ns ns R( Ch) ns .01 .01 ns .05 .05 Rt in Sec. .01 .01 ns ns .01 .01 Rt (Ach) ns .01 ns ns .01 .01 Rt (Ch)** .01 .01 ns ns .01 .01 W .01 ns .01 ns ns ns DW sig. sig. ns. ns. sig. sig. D ns .01 .01 .02 ns .01 d .01 .02 ns ns .01 ns Dd * ns ns ns ns ns ns M ns .01 .02 .01 .01 ns FM .01 .01 .01 .01 ns ns F .01 ns ns .01 .01 ns K .05 ns .01 ns .01 ns FK * ns ns ns ns ns ns Fc * ns ns ns ns ns ns C’ ns ns ns ns .02 ns C .02 ns .01 ns ns ns H ns .01 .02 .01 ns .01 (H) * ns ns ns ns ns ns A ** .01 .01 .01 .01 ns .01 Ad .05 ns ns ns ns ns A obj .02 .05 ns ns ns ns At ns .02 ns .01 .05 ns Sex .01 ns ns ns ns ns Obj .01 ns .02 ns .01 ns Cloud ns ns .01 ns .01 ns Blood .01 ns .01 ns ns ns P (Klopfer)** .01 .01 .01 .05 .05 .01 P (Asthana)** .01 .01 .01 .01 .01 .01 F+% .01 .01 .01 .01 .01 .01 *Lost their significance completely when controlled for productivity. **Remained significant irrespective of productivity. Discussion : Over all, the Rorschach record of military personnel of the present study was found to be constricted in terms of absolute mean values of the various indices like low R, and low H, high A+, Ad%, and high FM. Hertz (1977) reported that the ‘constriction in the records of the extremely inhibited, as in anxiety states, depressive conditions and in general, where the individual defends against the unhappy realities of his world, evades it, withdraws from it, or rejects it’. Constriction can also be found in guarded records, both normal and pathological. Restricted protocols in the military population compared with those of the general civilian populations are quite an anticipated and accepted mode of behaviors, regardless of intelligence level and diagnostic groups. 36 Dubey et.al.

Impact of Number of Responses on Rorschach 37 Table 5 Mean Percentages of Rorschach Indices Found Significant in the Three Groups of Subjects High Productivity Group Loe Pricitivity Group Total Variables =R>12(N=169) =R<11(N=131 Normal Schizo- Neurisis Normal Schizo- Neurosis Normal Schizo- Neurosis -phrenia -phrenia -phrenia N=75 N=53 N=41 N=25 N=47 N=59 N=100 N=100 N=100 Response (Mean) 14.79 15.74 13.10 10.68 9.30 9.92 13.76 12.71 11.22 W 28.06 32.27 36.34 37.45 55.38 42.34 29.87 40.20 39.48 D 67.34 55.97 60.38 61.42 34.52 54.54 66.21 48.62 57.31 d 3.24 8.64 2.21 0.37 8.06 1.51 2.69 8.42 1.87 F 32.65 43.51 34.04 26.59 51.50 44.55 31.46 46.26 38.68 M 9.80 8.95 5.03 9.36 7.31 5.44 9.73 8.41 5.25 FM 36.17 18.80 25.87 47.19 16.45 17.94 38.29 18.01 21.74 K - 0.95 4.12 - 1.07 2.41 - 1.02 3.20 C 1.28 6.22 7.09 1.49 4.08 5.34 1.30 5.50 6.14 H 9.66 9.72 6.33 9.73 4.62 6.65 9.66 7.94 6.50 A 51.58 36.34 38.70 67.04 32.90 41.53 54.57 35.16 40.19 A Obj 2.77 1.65 2.97 3.37 2.25 3.42 2.90 1.88 3.20 At 5.07 7.17 11.75 1.12 17.41 15.42 4.28 10.70 13.63 Sex 2.36 12.70 3.89 2.99 15.80 4.93 2.47 13.76 4.45 Obj 4.53 3.62 2.82 2.62 2.25 2.21 4.14 3.14 2.49 Cloud 1.08 1.52 6.33 0.74 1.18 2.41 2.54 1.41 4.27 Blood 1.28 4.89 6.10 0.74 2.25 4.13 2.83 4.01 5.03 P(Klopfer.) 32.79 17.47 30.00 44.50 17.84 36.59 35.10 17.62 33.42 P(Asthana.) 45.16 23.76 39.84 57.30 20.86 48.58 47.52 22.73 44.38 F+% 75.90 35.60 56.90 88.10 28.10 65.80 79.00 32.10 62.20 The normal subjects of the present study in the military setting may be wary, cautious, guarded perhaps evasive, unwilling to expose themselves. Hertz (1977) observed such attitudes and mental set in the prison population, in some industrial groups and in sociopaths. More often than not, constriction represents a rigid defensive effort, a means of maintaining a rigid hold on self and/or of insulating one self from the threat of the outside world. In a military setting, which is and has to be, necessarily an authoritarian one, this cannot be called a poor mode of adjustment. It is however, an adjustment that is probably necessitated by the stresses and strains of the regimentation of military life. Differential Utility of Rorschach Indices in Military Personnel : Three groups of normal, schizophrenic and neurotic subjects (N=100 in each) were compared for 45 Rorschach indices with a view to find Rorschach indicators discriminating among the groups. Of these, 31 variables turned out to be significant enough in discriminating the groups. In the response and reaction time category, total R, and R on achromatic and chromatic cards, total reaction time and reaction time on achromatic and chromatic cards separately were found to be significantly different in three groups of subject. In the normal group mean R was found to be 13.76 whereas in schizophrenics and neurotics it was 12.71 and 11.22 respectively. As far as reaction time is concerned, schizophrenics were found to be quickest in responding to the

Rorschach plates (Mean Rt. 14.43) and the neurotics took longest time i.e. 35.46 seconds. The normal stood in between (Average Rt. 23.29 seconds). These findings of R and reaction time are comparable with the other reported findings in relative terms. Neurotics are generally more inhibited and, therefore, may take longer time in responding and may give fewer responses. On the other hand, the acute schizophrenics are known to be quick and impulsive, with poor ego control. The normal inhibition is lifted in them. Therefore, they may give more responses and respond quickly. The other possible explanation for this might be that they are not much involved in the testing and want to get rid of it. This trend, however, is in agreement with some of the studies reported earlier (Kumar, 1959; Sandhu, 1978). A chronic schizophrenic subject is likely to be slower as compared to the acute one. In the military set up, acute cases are found in preponderance. Moreover, for the present study, only those patients who were heaving the first occurrence of psychiatric symptoms, and were not on active medications, were taken for the study. As far as Location categories are concerned except for white space responses all other indices like W, D, d, Dd were found to be significantly different in the three groups of subjects beyond the significance level of .01. Confabulatory responses were found in 31 percent of the cases in the schizophrenic group while in the other two groups i.e. normal and neurotic, this pathological response was not observed. Almost all the Rorschach researchers have come to a similar conclusion that confabulatory responses are pathological in nature, indicate over inclusive thinking and are pathogonomic sign of schizophrenia (Beck, 1938; Klopfer and Kelley, 1942; Rorschach, 1951 Quirck, Quarrington, Neiger and Slemon, 1962; Rapaport et al 1968; Beck et al 1971, Dubey, Sharma and Khanna, 1977; Pershad, Verma and Dubey, 1979). The high W of schizophrenics along with poor F+% indicated their poor organizational capacity (Klopfer et. al. 1954; Rapaport et al 1968). Small usual detail responses (d) and unusual details (Dd) responses were also found in significantly higher number of subjects in schizophrenic group as compared to normal and neurotics. In the Determinant category pure F was given by more number of subject in schizophrenia and M and FM were low as compared to the other two groups. According to Beck and Molish (1967) ‘Lambda’ or L is a measure of the strictly form determined associations which are unalloyed by any association scored as emotion determined (any other response; in a combination with form or in a pure state or as fantasy M). This is the ratio for all F to all non-F. They emphasis that when the ‘Lambda’ index is extremely high a tense constricted inner state is indicated; this constriction may represent depressive conditions; a washed-out energy, schizophrenic adaptation process; or an acute neurotic reaction in which repression is the major defense. In the present study relatively high F%is thus not out of proportion However, when compared with Western norm, this high F % is not really high to warrant any special attention (Davidson, 1950; Ulett, 1950; Klopfer et al 1954). The low number of movement responses in schizophrenia and neurosis groups as compared to normal control is the consistent findings observed by others also (Kumar 1959, 1963, Asthana, 1971; Premkumar 1975, Sandhu 1978) The acute cases of schizophrenia are known to give lower number of movement responses. M is 38 Dubey et.al.

hypothesized to be related with creativity . More creative persons give more M and less creative low M (Herdt, 1967; Dudek, 1960, 1968a, 1968b; Raychaudhuri, 1965 1971; Raychaydhari and Maitra, 1968). The intellectual functioning and creativity are known to be impoverished by the schizophrenic process itself (Lehman, 1967). Among the shading responses, K and cF were most frequently present in neurotic group compared to the control or schizophrenic groups. The control group most frequently gave the FK and FC responses. The differences were significant. This pattern was in the expected direction. The shading responses are known to be of diagnostic value in neurotic subject’s than schizophrenics (Ulett, 1950; Kumar, 1959; Asthana, 1971; Devos, 1975). The color responses on the other hand are generally reported as an indicator of schizophrenia (Weiner, 1961, 1964, 1965a, 1965b, Yen, 1964; Klopfer and Kelley, 1942; Rapaport et al, 1968; Beck et al 1971; Lambley, 1973). In the present study, however, both schizophrenics and neurotics gave almost similar response (Mean C schizophrenics=0.70 and neurotics=0.69 with SD’s of 1.11 and 1.04 respectively) of pure C responses. It is difficult, at the moment, to find out the cause of this contradictory finding of the present study. In the neurotic category, blood, anatomy and cloud responses were more in number as compared to schizophrenics. Most of the subjects in neurotic category used color to determine these responses. Color in neurotic cases aroused one’s repressed impulses. It mobilizes the anxiety, which by disrupting or stalling the person’s intellectual function prevents his engaging in prohibited activity. As expressed within the theoretical framework of Werner (1948), the behavior reflected in C is a diffuse reaction to environmental stimuli and obeys the pleasure principle and serves immediate need reduction. Shapiro (1960) refers to the effective quality in C as a “short circuitry”, an immobilizing of the delay functions, which would modulate tension discharge. Military personnel are generally viewed to live under constant disciplined environment. Their personal needs are thwarted probably because of strict regimentation. This may have lowered their threshold of responding to the environmental stimuli and they may react towards any further addition to it rather impulsively, which is reflected in the C type responses. In these persons it is symptomatic also of the propensity to display on anxiety on the soma (Beck and Molish, 1967). In the present study, therefore, even if C may not be discriminating between schizophrenics and neurotics, yet, this sign can be used as an indicator, suggestive of psychiatric illness in general. In the content category, 18 different content variables were analyzed, of which 10 were found significant in the discrimination of the three groups of subjects. Looking at the table 1,2,3, it is evident that variability is greater in the schizophrenic group with regard to H responses, ranging between 0-8 whereas for the other two groups i.e. control and neurotic, variability is less (Range 0-3). Paranoid schizophrenics tend to give more H responses and this might be the reason of greater variability in the present study. Otherwise, the trend observed here is consistent with the findings of other Indian studies (Kumar, 1959; Asthana, 1971). In the literature, in general, schizophrenics are known to give low H (Rapaport et al, 1968). (H) Responses, was less in number in all the three groups. However, the number was larger in schizophrenics than in the other two groups. With regard to A+Ad, and ‘At’ responses, the findings are similar to the findings reported in the Indian literature as cited earlier. The ‘Sex’ responses, however, Impact of Number of Responses on Rorschach 39

were found in significantly higher number of subjects in schizophrenic group and ‘cloud’ were more in neurotics. The Blood and Cloud contents were found in significantly more number of subjects in neurotic group as compared to schizophrenics and normal. The number of Popular and F+% are generally believed to be low in schizophrenic subjects and high in the normal group (Kumar, 1959; Mukerjee, 1960; Dubey, 1979, 1981; Prabhu, 1967; Asthana, 1971; Gupta, 1975). Neurotic subjects stand in between. The same trend is confirmed here also. The rejection of cards by neurotics and schizophrenics did not turn out to be significantly different from that in the control group. Schizophrenic and neurotic groups both showed rejection of cards whereas normal rejected very few cards (Ulett, 1950; Piotrowski, 1957; Tamkin, 1966). In the control group, the reality oriented cads (card No. III, V, VIII) and first two easy card were not rejected by any subject, whereas, rejection on these cards were present in the other two clinical groups. As mentioned earlier it has been our experience and of many others, that the number of responses on Rorschach will change the psychological significance of other variables. In the present study, our aim was to find out the Rorschach indices, which could differentiate the groups i.e. normal, schizophrenics and neurotics. Among the 31 variables found significant with out controlling for the productivity, only 25 remained significant when analyzed after controlling for the productivity (Number of R). The 6 variables which turned to be not significant were Dd, FK, Fc, C’ (H) and Ad. These 6 variables were quite insignificant for both the groups:‘high productivity group’ (HPG) and ‘low productivity group’ (LPG). In addition to these, W, K, C, Ad, Sex, Obj, Cloud and Blood variables did not turn out to be significant in LPG in differentiating the three groups. In the HPG, two variables i.e. R achromatic and “At” lost their significance. The variables which did not show any change in their level of significance even after controlling the productivity (for R) were Rt chromatic A, P and F+% (Out of six comparison for each variable when five or more were found significant (table 4). Thus, it may indicate a need for further study of these variables after controlling precisely for the number of responses (Total R). The profile of the subjects in HPG suggested that normal subjects obtained more responses on FM, A, A Obj, P and F+ % and low on W, d, F, K, C, Sex and Blood in comparison to schizophrenic subjects. In LPG, Normal subjects obtained more responses on D, M, FM, H, A, A Obj, P and F+% and low on d, At, and Sex in comparison to schizophrenics. The variables which were found discriminating between schizophrenics and normal in both HPG and LPG are D and Sex (more in schizophrenia), FM, A obj, P and F+% (low in schizophrenia), in addition to the pathological responses DW and (H) which were present in schizophrenics. These were the variables which had been invariably found discriminating between schizophrenics and normal in a number of studies (Asthana, 1971, Klopfer et al 1954, Kumar, 1959, 1963). More W, C, At and low H and M responses are also demonstrated by these studies as significant indicators. The present study clearly brings out that more W, C are not always a sure sign of schizophrenia. But when the number of R in a protocol is 12 or more, these variables do indicate schizophrenia. Low M and H are found only in cases where the 40 Dubey et.al.

number of responses are 11 or less. This further strengthens the point that there is a need to control the productivity. Without controlling productivity, low FM, A%, P, F+% and high Sex responses and d along with DW and (H) may be considered as strong indicators of schizophrenia. Among the first grade indicators (which remained significant even after controlling productivity) differentiating between normal and neurotics were D, M, FM, H, A,P, and F+%. All these indices, which are often described as signs of neurosis, were low in neurotics as compared to their normal counterparts. It is important to know whether two clinical groups taken in this study could be differentiated. The presence of pathological responses i.e. DW and (H) along with low P and low F+% are the first-degree indicators of schizophrenia rather than neurosis. If a person gives 12 or more responses, more d, M, F, Obj and Low K, At and Cloud would add to the diagnosis of schizophrenia rather than neurosis. If a person gives low number of responses (i.e. R is less than or equal to 11), then the chances of appearing d, M, At, Cloud and Object would be less, hence low number of D, H and A would only differentiate schizophrenics from neurotics. After viewing the results of the present study and the suggestions given by Fiske and Baughman (1953) it becomes important to make separate norms based on the numbers of responses in different range such as 20-25, 26-30,31-35,36-40 and so on. As such the available norms – Indian as well as Western do not carry much meaning while interpreting Rorschach protocol. In 1953, Fiske and Baughman reported that practitioners feel that the variation in the total number of responses is too much to be able to interpret the ratio scores adequately. Also, the meaning of the indices changes depending upon the length of the protocol, because the relationship between Rorschach scores and the total number of responses is complex and curvilinear. Many workers compute percentage ratio in an effort to control the length of the protocol. Holtzman (1956) pointed out that such procedures were very unsatisfactory, not only because of the non-linear relationships between R and other Rorschach’s scores, but also because of the crude, unstable and metric qualities of most Rorschach variables. Holtzman et al (1956) pointed out that much of the controversy over the Rorschach arises from the failure to distinguish between the Rorschach as a projective technique in the hands of a skilled clinician, and the Rorschach as a psychometric device, that yields scores having relevance for personality assessment. The analysis of responses to inkblots has ranged all the way from one extreme to the other of the projective psychometric continuum. Wayne Holtzman developed an inkblot test to overcome some of the limitations of the Rorschach. The main limitation of the Rorschach, as experientially determined, was the problem of variation in the length of the protocol (Fiske and Baughman, 1953; Dubey et al, 1978, 1979, 1989). As Fiske and Baughman pointed out, the relationship between Rorschach scores and the total number of responses are complex and curvilinear. Consequently, the usual effect of R linear regression methods for removing the confounding effect of R will generally fail. Impact of Number of Responses on Rorschach 41

Dubey, (1982), in a study of 300 subjects, found that most of the Rorschach indices are dependent upon the number of responses. When the groups of Normal, Neurotics, and Schizophrenics were divided, on the basis of number of responses, into high productivity and low productivity, many indices, which were found to be significant lost their significance. It further strengthened the findings of Fiske and Baughman, and supported the intention of Holtzman. The advantage, which Holtzman introduced in his test, was to offer an alternate series of the inkblot stimuli test for reassessing the personality after some type of intervention. Holtzman provided 45 cards in each series. The subject is required to give one response per card. Holtzman categorically selected only 22 variables such as: reaction time, location, form definiteness, form appropriateness, color, shading, movement, pathogonomic verbalization, integration, human, animal, anatomy, anxiety, hostility, barrier, penetration, popular, etc. His test is said to measure almost the same aspects of personality that are measured by the Rorschach. Holtzman has clearly emphasized the psychometric approach. The Holtzman test has wide application and is popular. However, the research output is not as prolific as that of the Rorschach test. To overcome the problems of the complicated Rorschach Scoring System and to make the Inkblot Test more user friendly, Wilfred A. Cassell (1980) after years of field-tested data, provided the Somatic Inkblot Series for personality assessment, diagnostic evaluation and therapeutic intervention. The test was developed specifically to understand the manifestation of problems through somatization and to hear the suffering individual’s “inner cry.” (Cassell, 1980, 1984, 1990; Cassell and Dubey, 2003, 2004). The test images are viewed on a television using a CD or VCR. The subject’s responses are recorded on response sheet. The procedure can be done while the patient waits for his/her turn at a clinic or a hospital. In some cases where the individual has good ego strength, the procedure can be completed at home. The Somatic Inkblot Series provide images in three forms: on Cards, in a Booklet and on Videotape/CD. SIS –I (20 images on cards/Videotapes). SIS-II (62 images in a Booklet /Videotapes/CD). SIS-Living Images (40 images on Videotapes) Except SIS-I card, all other forms of the series can be used as self-administration and group-administration under supervised instructions. The SIS may be used as a guide to develop personalized visual imagery for meditation and enhanced spiritual awareness. When the viewer selects the “three most liked images”, these can often be used as an effective visual stimulus to induce trance-like states with their associated physiologic relaxation. Having the subject rate the positive valence of the SIS flowers and nature scenes at the end of the test ordinarily is a more effective way of identifying hypnotic and healing images. These can focus consciousness away from painful body sensations and disturbing memories of current stressors and past traumatic events. This can initiate an imaginary trip away from 42 Dubey et.al.

immediate stressful reality into an inner world of peace and positive spirituality. Timespace-energy may be dramatically fused paving the way for inducing mystical connections between the self and loved ones - either living or deceased. The individual’s spirit may rise above the relatively brief temporal reality of one’s body in order to prepare for death and ultimate transformation into higher planes of spiritual existence. For physicians, therapists and researchers, the body, its organ systems and its perceived functions are “doorways to the mind.” Observing and assessing how people perceive or misperceive body and organ function can learn much about their innermost thoughts and feelings. What they see in ambiguous and semi-ambiguous inkblots shows how they see themselves, the quality of their life and lifestyle, their adjustment to conflict, their coping skills and their view of the reality of life. The Somatic Inkblot Series can help therapists more sensitively “hear” a suffering individual’s cry for help, the “inner cry” that is not only hidden from others, but often hidden from one’s own conscious awareness as well. This is the “magic”; the unique and distinguishing feature of projective testing. By developing a practiced eye and ear for this imagery, therapists can more directly share the perceptual world of their patients with less interference, and fewer variables than in structured interviews or so-called “paper and pencil tests.” If, as the saying goes, “a picture is worth a thousand words,” inkblots are picture recognition tests, and therefore are potentially more powerful than verbal interviews and tests. Therapists willing to more directly know and experience the patient’s psychic pain will be rewarded with clearer understanding of the psycho-dynamics involved, and therefore be able to provide more effective therapy. In clinical settings, the Somatic Inkblot Series (SIS) has both diagnostic and therapeutic applications. In regard to the former, it has been used extensively as a structured, projective, diagnostic procedure. Through the power of projection it can reveal material from the inner self (Cassell,and Dubey, 2001,2003;Panek, 2001; Sperbeck, 2000). The 62- image series ranges from those that are relatively unstructured, to the semistructured, to the highly structured. This affords the trained examiner a wide range of opportunities for the comprehensive examination of the subject’s cognitive and emotional processes. Research data obtained from a variety of clinical settings internationally indicates that the clinical investigators using the SIS technology can distinguish different diagnostic categories with acceptable levels of statistical confidence (Banerjee et al, 1998; Cassell and Dubey, 1997; Chaudhury et al, 2001; Dubey et al, 1995; Mitra and Mukhopadhyay, 2000; Mohn et al, 2002; Nicolini, 2000, 2002; Pandey et al, 1999, 2001; Rathee et al, 1998, Saldanha et. al. 2002; Sarkar et al, 1999; Cinzia, 1998; Srivastava, 2002). In the future, SIS derived projective material may be included in formal psychiatric manuals to sharpen diagnosis. Since projective tests are not based on verbal communication, they more effectively penetrate a person’s “outer shell” of defenses and surface behaviors. Unlike personality and intelligence tests, projective tests do not require reading questions or manuals, so they more directly access mental processes. They use the language of dreams, visual Impact of Number of Responses on Rorschach 43

imagery and symbolic thought, the most basic forms of thinking and expression. Projective tests speak the language of repression and bring whatever is buried in the mind closer to consciousness, so it is accessible for processing. The Somatic Inkblot Series has a very simple scoring system. It is less complicated than existing inkblot tests, since it emphasizes content analysis. The eleven scoring categories found to be important in understanding and interpreting the protocols have been given below (for details see Cassell and Dubey, 2003 Interpreting Inner World through Somatic Imagery): 1. Total Number of Responses 8. Typical Responses 2. Human Responses 9. Atypical Responses 3. Animal Responses 10. Rejection of Images 4. Anatomical Responses 11. Pathological Responses 5. Sex Responses a. Pathological Anatomy (PAS) 6. Movement Responses b. Depression (D) 7. Most Typical Responses c. Hostility and Aggression (HAS) d. Paranoia (P) Since it follows mainly content analysis, it helps in hearing the inner cry of the suffering individuals. The patient is not interested in the procedure you are going to follow, but eager to know “can you hear me”? “Can you help me”? And “can you relieve my pain I’m suffering from”? The Somatic Inkblot Series do take into account the scoring indices in establishing broader diagnosis and differences in the response pattern before and after therapeutic intervention. Instead of reaching on any conclusion through statistical analysis of indices it emphasizes on content analysis and psychoanalytical procedure. The authors believe that SIS instrument with the use of Video/CD technology will be the test of 21st century. Conclusion : Among the 31 variables found significant with out controlling for the productivity, only 25 remained significant when analyzed after controlling for the productivity (Number of R). The variables which did not show any change in their level of significance even after controlling the productivity were Rt chromatic A, P and F+% . Thus, it may indicate a need for further study of these variables after controlling precisely the number of responses (Total R). Reference : Asthana, H.S. (1971) Normative data on Rorschach Inkblot for Indian Sample. Unpublished Research Report. Deptt. of Psychology, Saugar University, Saugar. Banerjee,S., Mukhopadhyay,A and Singh,U. (1998) An Indepth Study of Somatization in Heroin Addicts Through SIS-I & Rorschach Inkblot Test. SIS J. Proj, Psy. & Mental Health, 5:33-39. Beck, S.J. (1938) Personality Structure in Schizophrenia: A Rorschach Investigation in 81 Patients and 64 Controls. Nervous and Mental Diseases. Monograph. 63 : IX + 88. 44 Dubey et.al.

Beck, S.J.; Beck, A.G.; Levitt, E.E. and Molish, H.B. (1971) Rorschach’s Test Vol. I. Basic Processes. Grune & Stratton, New York. Back, S.J. and Molish, H.B. (1967) Rorschach’s Test. Vol. II. A Variety of Personality Pictures. Grune & Stratton, New York. Cronbach, L.J. (1949) Statistical Methods Applied to Rorschach Scores : A Review. Psychological Bulletin, 46:393-429. Cassell, W. A. (1980) Body Symbolism and the Somatic Inkblot Series. Anchorage, Alaska. Aurora Publishing, Cassell, W. A. (1980) Computerized Projective Testing as an Aid in Medical Diagnosis. Alaska Medicine, 26: 1-9. Cassell, W. A. (1984) Somatic Inkblot Series Video, SIS Center . Anchorage, Alaska (USA) Cassell, W. A. (1990) Somatic Inkblot Series Manual. SIS Center, Anchorage, Alaska (USA), Cassell, W. A. and Dubey, B. L.(1997) Therapeutic Dream Stimulation with SIS- Video. SIS J. Proj. Psy. & Men. Health, 4: 3-23. Cassell, W. A. Dubey, B. L. and Roth, G. J. (1997) Medical, Psychological and Spiritual Application of the SIS Inkblots. SIS J. Proj. Psy. & Mental, Health, 4: 89-112. Cassell, W. A., Illardei,F.J., Collins, A., Mishra, M. and Dubey, B.L. (2001) Optimizing Spiritual Healing by Assessing Dream and SIS Imagery. SIS J. Proj. Psy. & Mental Health, 8, 75-94. Cassell, W. A. and Dubey, B. L.(2003) CD Version of SIS II Images . SIS Center, Anchorage, Alaska (USA), Cassell, W. A. and Dubey, B. L.(2003) Interpreting Inner World Through Somatic Imagery. SIS Center, Anchorage, Alaska (USA). Chaudhury, S., Raju, M. S. V. K., Dubey, B. L., John T.R., Salujha, S.K. and Srivastava, K. (2001) Alopecia Areata: Evaluation Using Psychological Tests and the Somatic Inkblot Test. SIS J. Proj. Psy. & Mental Health, 8, 143-148. Cinzia, S. and Ferro Roberto. (1998) SIS-I and Body Image Evaluation in Subjects Suffering from Series Obesity. SIS J. Proj, Psy. & Mental Health, 5: 105-113. Davidson, H. (1950) Ameasure of Adjustment Obtained from the Rorschach Protocol. Journal of Projective Techniques 14 : 31 38. Devos, A. (1975) An Introduction to Rorschach Technique. Unpublished Manual. National Institute of Mental Health and Neuro-sciences, Bangalore. Dubey, B.L. (1979) Rorschach Indices of Psychiatric Patients in Army. Indian Journal of Clinical Psychology, 6 :175-179. Dubey, B.L. and Pershad, D. (1978a) Validation of the Proposed Statistical Design for Rorschach. India Journal of Clinical Psychology, 5 :91. Dubey. B.L. and Pershad. D. (1978b) Shift in the Clinical Significance of Indices of the Rorschach when Controlled for Responses. Perspective in Psychological Researches, 1 : 119-122. Dubey. B.L. Pershad, D. and Verma, S.K. (1979) Rorschach Responses of Different Type of Neurotics. Journal of Rajasthan Psychiatric Society, 3 : 2, 29-32. Dubey. B.L. (1982) A Pragmatic View of Rorschach Inkblot Technique. National Psychological Corporation Agra, India. Impact of Number of Responses on Rorschach 45

Dybey. B.L., Cassell, W.A., Pershad, D. and Dwivedi, P. (1995) Diagnostic Utility of Somatic Inkblot Series. SIS J. Proj. & Mental Health, 2: 77-84. Dubey. B.L. (1989) Rorschach Variables as Affected by the Length of the Protocol. Indian Psychological Review, 35-1, 12-16. Dubey, B.L.; Sharma, G.C. and Khanna, S. (1977) A Comparative study of Over Inclusive Thinking on Rorschach Inkblot Test. ISPT Journal of Research, 1 :99-102). Dubek, S.Z. (1960) Creativity and the Rorschach Human Movement Response : An Analysis of the Relationship Between Quality and Quantity of M and Creative Expression in Artist and Non-artist Group. Ph.D. Thesis, New York University New York. Dubek, S.Z. (1968a) An Active Energy System Correlating Rorschach M with Case of Creative Expression. Journal of Productive Techniques and Personality Assessment, 32, 453-461. Dubek, S.Z. (1968b) Regression and Creativity. Journal of Nervous and Mental Disease, 1947 : 535-546. Fiske, D.W. and Bughman, E.E. (1953) Relationships Between Rorschach Scoring Categories and the Total Number of Responses. The Journal of Abnormal and Social Psychology, 48 : 25-32. Goldfried, M.R.: Stricker, G. and Wenier, I.B. (1971) Rorschach Handbook of Clinical and Research Applications, Prentice-Hall Inc, Englewood Cliffs, New Jersey. Gupta, S.C. (1975) A Study of Etiological Factors in Murderers. A Psycho-social Investigation. Ph.D. Thesis, Kanpur University, Kanpur. Herdt, B.F. (1967) The Relationship Between the Human Movement Factor in the Rorschach and Overt Motor Activity. Ph.D. Thesis to St. John’s University. Hertz, M.R. (1942) Rorschach : Twenty Years After. Psychological Bulletin, 39 : 529-572. Hertz, M.R. (1977) Personal Communication. Case Western Reserve University, Cleveland, Ohio. Holtzman, W.H. Inkblot Perception and Personality. University of Texas Press, Texas, 1956. Kolpfer, B.: Anisworth, M.D.: Klopfer, W.G. and Holt. R.R. (1954) Developments in the Rorschach Technique. Vol. 1. Technique and Theory. World Book Coy, New York. Klopfer, B. and Kelley, D.M. (1942) The Rorschach Technique. World Book Coy, New York. Kumar, B. (1974) Application of Weighted Sign Test of Significance to the Two and K Independent Sample Case. Journal of Social and Economic Studies, 11 : 97-102. Kumar, P.(1963) The Rorschach Test in Schizophrenic and Normal Groups. Indian Journal of Psychology, 38 : 121-124. Mitra, G. and Mukhopadhyay, A. (2000) A. Psychological Factors in Drug Addicts and Normals: A Comparative Study. SIS J. Proj, Psy. & Mental Health, 7:53-78. Mohn,D. (2002) Application of the SIS Board: Editorial. SIS J. Proj, Psy. & Mental Health, 9: 79-80. Meehl, P.E.(1975) When Shall We Use Our Head Instead of the Formula. Journal of Counseling Psychology, 4 :268-273. Mukherjee, M.(1960) Normal Indian Personality as Projected in the Rorschach Test. Ph.D. Thesis, University of Lucknow, Lucknow. 46 Dubey et.al.

Nicolini, P. (2000) The Corporeal Perception in Subjects with Psychosomatic Disorders Evaluated with the SIS-I Test. SIS J. Proj, Psy. & Mental Health, 7: 127-132. Nicolini, P. (2002) Diagnostic Value of SIS-I and EDI-2 Tests in the Obese Patients- Presentation of a Clinical Case. SIS J. Proj, Psy. & Mental Health, 9: 133-152. Panek, P. E. (2001) Editorial: Projective Psychology in the New Millennium: Issues and Challenges. SIS J. Proj, Psy. & Mental Health, 8:73-74. Pandey, R., Tripathi, V.R.M. and Tripathi, S. (2001) Age Related Changes in SIS-II Response Contents. SIS. J. Proj, Psy. & Mental Health, 8:35-40. Pandey, R., Misra, M., Mishra, R. and Dwivedi, C. B. (1999) Stability of SIS-II Response Contents Across Time and Predesignated Image Clusters. SIS J. Proj, Psy. & Mental Health, 6: 31- 37. Persad, D.; Verma. S.K.and Dubey, B.L..(1979) Pathogonomic Signs of the Rorschach : How Useful are they? Briish Journal of Projectove Psychology and Personality Study. 24 (2), 27-29. Piotrowski, Z. A. (1957) Percept Analysis. The Mach Millan Company, New Yourk. Prabhu, G.G.: (1967) The Rorschach Technique with Normal Adult Indians. Indian Psychological Review, 3:97-106. Premkumar, R (1975) Thought Disorders in Schizophrenia. The Kerala Journal of Psychiatry, 3:54-59. Quirk, D.A.; Quarrington, M.; Neiger, S. and Slemon, A.G.(1962) The Performance of Acute Psychotic Patients on the Index of Psychological Thinking and on Selected Signs of Idiosyncrasy on the Rorschach. Journal of Ortho-psychiatry, 16:516-524. Rathee, S. P., Pardal,P.K. and John, T.R. (1998) Diagnostic Validity of SIS-II among Psychopathological Cases of Armed Forces. SIS J. Proj, Psy. & Mental Health, 5:139-144. Rapaport, D. (1946) Diagnostic Psychological Testing Vol. II. Year Book Publishers, Chicago. Rapaport, D.; Gill, M.M. and Schafer, R. (1968) Diagnostic Psychological Testing. International Universities Press Inc. New York. Raychaudhuri, M.(1965) Personality Correlates of Creativity. Samiksha 19 : 3, 107-134. Raychaudhuri, M. (!971) Relation of Creativity and Sex to Rorschach Response. Journal of Personality Assessment; 35 : 27-31. Raychaudhuri, M. and Mitra, A.K. (1968) Relationship Between Level of Card Projection of Movement Responses as Measured by Rorschach M. Welsh Mv and a Drawing Completion Task. Indian Journal of Psychology, 43 : 30-36. Rorschach, H.(1951) Psycho Diagnostic (Translated by P. Lemkay and B. Kronenberg) 5th Ed. Gune and Stratton Inc. New York. Saldanha, D. (2002) Profile of Militants: An Attempt to Study the Mind of Militants. SIS J. Proj, Psy. & Mental Health, 9: 23-32. Sarkar, P., Rathee, S.P. and Neena,N. (1999) Comparative Efficacy of Pharmaco-therapy and Bio-Feedback among Cases of Generalised Anxiety Disorder. SIS J. Proj, Psy. & Mental Health, 6: 69-77. Srivastava, A. K. (2002) Somatic Inkblot Series-I: A Meta Analysis. SIS J. of Projective Psychology & Mental. Health, 9: 33-37. Impact of Number of Responses on Rorschach 47

Sandhu, J.S. (1978) Rorschach Responses in Schizophrenia India Journal of Clinical Psychology, 5 : 145-153. Shapiro, D. (1960) A Percentual Understanding of Color Response. In M. A. Rickers-Ovsianking (Ed) Rorschach Psychology. John Wiley and Sons, New York, pp 1540201. Siegel, S. (1959) Nonparanetric Statistics. McGraw Hill, New York. Tamkin, A.S.(1966) The Determinants of Rorschach Card Rejection: AR. Journal of Clinical Psychology, 22; 469-470. Ulett, G.A. 1950 Rorschach Introductory Manual. Education Publishers, St. Louis. Weiner, I.B.: (1961) Three Rorschach Scores Indicative of Schizophrenia. Journal of Consulting Psychology, 25 : 436-439. Weiner, I.B. (1964) Pure C and Color Stress as Rorschach Indicators of Schizophrenia. Perceptual and Motor Skills, 18 : 484-486. Weiner, I..B.(1965a) Rorschach Color Stress as a Schizophrenic Indicator: A Reply. Journal of Clinical Psychology, 21: 313-314. Weiner, I.B. (1965b) Follw-up Validation of Rorschach Tempo and Color Use Indicators of Schizophrenia. Journal of Prohective Techniques and Personality Assessment, 29: 387-391. Werner, H. (1948) Comparative Psychology of Mental Development. Follett, Chicago. Yen, Yi-shu (1964) The Diagnostic Indicators of the Delusion of the Schizophrenia in the Rorschach Test. Acta Psychologica Taiwanica, 6: 63-70. 48 Dubey et.al.

Relevance of Beck Norms of Rorschach Inkblot Technique on Indian Population-an Exploratory Pilot Study on Normal Subjects D.K.Singh, Anjali Singh and Amool Ranjan Singh One hundred normal subjects in the age range of 18-50 years; both male and female with minimum education up to 12th standard were taken for the study. It was a purposive sampling Rorschach Test and PGI General Well-Being Measure were administered individually. No individual with the history suggesting mental retardation,) substance abuse, significant medical, neurological or psychiatric disorders and personal history of mental illness were included in the study. Results suggest that the findings of Indian studies do not match either with each other or with the norms suggested by Samuel Beck. It further emphasizes the need of Indian Norms on larger population. Rorschach test is one of the oldest and most widely used psychodiagnostic tools for adults in the clinical setting (Dubey, 1981). The inkblot techniques, which are commonly used in the field of Clinical Psychology, have been critically evaluated by prominent persons in the field (Cronback, 1949; Zubin et al. 1965; Shukla, 1977 & Dubey et al. 1981). Various studies show that the role of culture and language in the cognitive processes of individuals has been a source of speculation. Some researchers view that the form of a particular language strongly influences the shape and form of perceptions (Lenniberg, 1961; Bronw & Lennenberg, 1954; Carroll & Casagranda, 1998). Moon & Cyndick (1983), in cross-cultural studies on Rorschach found that the test yields some differences in perception as a result of cultural influences. Various studies show that cultural factors like language, technological changes, influence the shape and form of perception. Initial perception and subsequent response is definitely determined by the individual’s interpretation of a given stimuli in context to the culture the person belongs. Similarly, the norms developed by Beck (1942) were more suited to a particular culture. Again, some of the norms developed by Indian researchers in 60’s and 70’s were also based on specific population. The scientific advancement has certainly brought about significant and visible changes in every sphere of human life. These changes have eventually changed human perception towards different stimuli present in environment. In view of the above, the present study has been planned to carry out a pilot study on Rorschach test on normal population. The study aims to develop initial response data in the areas of Location, Determinant, Content and Popular percept and to examine the trend of responses with Beck’s original norms and Norms on Indian Population. Material and Methods Sample: One hundred normal subjects in the age range of 18-50 years; both male and female with minimum education up to 12th standard were taken for the study. It was a purposive sampling. Rorschach Test and PGI General Well-Being Measure were administered individually. No individuals with the history suggesting mental retardation, substance abuse, significant medical, neurological or psychiatric disorders and personal history of mental illness were included in the study. They belonged to middleclass socio-economic status from urban and semi-urban areas. D.K.Singh and Anjali Singh, Research Scholar and Amool Ranjan Singh, Ph.D., Professor, Dept of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi- 834006(India) Telefax: 91-651-2450813(W)2233687(H) Email:dr_amool_r_singh@rediffmail.com Key Words: Beck Norms of Rorschach.

Tools : Socio-demographic data sheet especially designed for the study PGI General Well-Being (Verma et.al. 1998) Rorschach Psycho diagnostic Procedure : The subjects who scored below cut off point on PGI General Well Being measure were selected for the study. Reliable informant crosschecked information. Rorschach Psycho diagnostic was administered according to standard procedure given in the manual (Beck’s system). Analysis of Data : The mean, range and SD were calculated for each Rorschach indices separately and compared with original norms. Results : Table 1 shows gross disparity in the range of total number of responses (16-40) along with initial reaction time (10-61 sec). Almost all the indices in the present study was much below than the values given in the Beck’s manual. The total scores obtained were less than 50% in comparison to that of Beck’s manual. Table 1 Showing Mean, SD andRange of Different Indices Variables Present study Mean Remarks Mean SD Range (Beck’s system) R 21.46 8.90 16-40 32.65 34% belo IRT 23.10 16.0 10-61 15-30 W 5.02 3.50 1-13 5.50 D 13.26 3.95 9-20 22.85 42% below Dd 2.2 1.01 1-10 3.02 S 0.84 0.50 1-5 1.90 56% below M 2.02 1.01 1-7 3.50 43% below F+% 40.02 18.68 15-31 79.25 50% below c .44 .26 1-5 .49 CF .72 .34 1-5 1.44 50% below Y YF, FY .89 1.10 1-6 1.96 55% below V .02 - 2-4 1.84 98% below FV .15 - 2-5 1.04 86% below Afr .30-.56 - - .40-.60 C sum 2.60 1.95 1-10 3.11 H 3.08 2.16 1-11 4.02 Hd 1.48 1.10 1-8 1.78 An .79 .70 4-4 1.55 49% below A% 46.30 18.00 31-59 46.65 50 Singh

Table 2 Comparison with Other Studies Done on Indian Population IndicesFindings of Asthana Kumar Prabhu Asthana D’Netio Dubey Beck’s Range of present 1963 1961 1967 1971 1974 1989 manual disparity study R 21.46 22.10 28.00 33.00 16.00 13.80 32.35 16-33 W 22.7% 9.33% 29.46% 27% 9.33% 15.00% 29.8% - 9.33-29.8 D 59.89% 16.97% 57.8% 51% 16.97% 51.0% 66.0% - 17-66 Dd 10% 6.70% 6.21% 9% 6.70% 9.00% 0.2% - .2-10 F+% 40.02 83.14 83.14 - 31.46 - 79.25 32-84 C .44 - - 0.20 - - .18 .49 .20-.49 Fc 1.01 3.08 - 3.70 3.08 - .57 1.36 .57-3.08 CF .72 1.61 - .90 61.63 - .34 1.44 .34-1.63 M 2.02 3.83 1.00 3.70 3.83 - 1.34 3.50 1-3.83 A% 46.30 36.98 38.70 36.98 36.98 58.50 - 46.65 37-59 P 4.3 5.30 5.30 4.90 5.30 6.00 4.80 5.7 4-6 Discussion : Findings of this study and some other studies carried out in India on different samples do not match with the scores of Beck’s manual on different indices. Norms given by different researchers vary significantly. Wide variation in different studies was found on indices i.e., Total Responses, Whole responses, major Detail responses, minor Detail responses, F+%, Form dominated Color responses, and Color dominated Form responses. In the present study mean of total number of Response is 21.46, which is similar to the findings of Kumar 1961 (22.10), but below the findings of Asthana’s (963) who has given R=33 and Beck’s norm 32.35. It is higher than D’Netto’s (1974) findings. Again in the present study value of W response is 22.7% which is less than the findings of Kumar (1961), Prabhu (1967) and more than the findings of Asthana (1971) and D’Netto’s (1874). Value of detail response in present study is similar to the findings of other Indian studies except with Asthana (1971). In the index study, obtained value is 10%, which is much higher than the other reported study. Value of pure Color response in present study is .44, which is approximately similar to Beck’s norms, but double than the value reported by Prabhu (1967) and Dubey (1989). However no major disparity was noticed in Movement response, Animal responses and Popular responses. Conclusion : Findings of the Indian studies do not match with the findings of Beck’s study. It suggests that there is a need to develop Indian Norms on a large population which can help in diagnostic evaluation. A number of scoring indices of Rorschach protocol is said to be dependent on the number of responses given by the subjects. Therefore, a procedure as suggested by Dubey(1982) for controlling the protocol for the productivity is warranted. Beck Norms of Rorschach 51

References : Asthana, H.S. (1963). A Rorschach Study of the Indians. Rorschachiana, 45, 8, 283-286. Caroll & Casagranda (1958). The Function of Language Classification in Behaviour. In E. Macoby (Ed.) Reading in Social Psychology, New York. Holt Rinehart & Winston. Cronback, L.J. (1949). Statistical Methods Applied to Rorschach Scores. Psychological Bulletin, 46, 393-429. D’Netto, T.B., Kishore, R. and Ruggo, R.K. (1974). Analysis of Rorschach Response of Normal Army Personnel. Journal of Clinical Psychiatry, 2, 87-92. Dubey, B.L. (1989). Rorschach Profile of Indian Executive. Indian Journal of Clinical Psychology, 16, 74-76. Dubey. B.L., Pershad, D. & Verma, S.K. (1981). An Evaluation of Rorschach as a Clinical Tool. Indian Journal of Clinical Psychology 8, 2, 157-163. Kumar, P. (1961). Rorschach Test in Psychoneurotics and Normal Groups. Indian Journal of Psychology 36, 169-172. Lennenberg (1961). Color Naming, Colour Recgonition, Colour Discrimination: A Reappraisal. Perceptual and Motor Skills, 12, 375-382. Moon, T.J. & Cundick, B.P. (1983). Shifts and Constancies in Rorschach Responses as a Function of Culture and Language. Journal of Personality Assessment. 47 (4), 345-349. Pershad Dwarka, Parekh, C. Suresh (2001). A Practical Manual for the Rorschach Test, H.P. Bharagava Book House Publications. 1st edn, Agra. Prabhu, G.G. (1967). The Rorschach Techniques with Normal Adults Indians. Indian Psychological Review, 97, 106. Shukla, T.R. (1977). Projective Techniques in India. Indian Journal of Clinical Psychology, 4,2, 105-107. Zubin, J., Eron, L.D. & Schumer, F. (1965). An Experimental Approach to Projective Techniques, New York. Wiley. 52 Singh

Diagnostic Indicators on SIS-I and Rorschach Among Manic and Depressive Patients Deepak Kumar, Jagdish Kumar and Rakesh Kumar The present study reports Rorschach and SIS-I diagnostic indicators of manic and depressive disorders as well as the diagnostic compatibility of the two tests. Two clinical groups: manics (N=50) and depressives (N=50) along with a normal control group (n=50) were tested individually on Rorschach and SIS-I. The individual protocols on these tests were scored on several common indices and between group comparisons was done using t-test. Findings revealed that the SIS- I provided important diagnostic information not only for differentiating clinical cases from normal healthy subjects but also for differentiating manics from depressives. It was also observed that the diagnostic efficacy of the SIS-I was comparable to that of the Rorschach and both tests were found to provide psychometrically compatible information in a sample of normal subjects. The Somatic Inkblot Series (SIS) is the latest development in the inkblot technique (Cassell, 1965, 1980, 1985). There are five forms of SIS: SIS-I (20 cards), SIS-II (booklet of 62 images), SIS-II video, SIS-II Video, and SIS living images. The quantitative analysis of the SIS responses have been made simple and its diagnostic use can be learnt more easily as compared to Rorschach. SIS is considered as a continuation of Rorschach’s conceptualization and relies on the same psychometric idea that individuals project their own unique mental imagery into ambiguous and semi-ambiguous visual stimuli. Researches during the last decade have proved SIS not only as a psychometrically sound and efficient diagnostic instrument but also as an adjunct to psychotherapy. It can help therapist more sensitively in hearing the inner cry of the suffering individual for help, the inner cry that is hidden not only from others but often from one’s own conscious awareness as well. Since these are somatic inkblots involving body and organ imagery, a variety of personal problems and mental disorder have been identified through them. SIS-I has been investigated in coronary patients (Dubey et.al 1994), drug addicts (Mukhopadhyay et.al 1996), normal subjects (Rathee & Singh, 1996), obesity (Cinzia & Ferro, 1998), chronic schizophrenic (Kumar et. al, 2001), achondroplosia (Khromov, 2001), militants (Saldanha, 2002) and manic patients (Kumar et,al , 2003). A few researchers have also demonstrated that the SIS provides diagnostic information compatible to Rorschach (Dubey, Mishra, Dwivedi, and Mishra, 1994). However, such studies have addressed only a few diagnostic categories and replication studies to cross-validate the findings are scant. Taking this gap in the SIS literature into account, the present study makes an effort to identify and compare the Rorschach and SIS diagnostic indicators of manic and depressive patients. The comptability of the Rorschach and the SIS has also been examined in the normal population by correlating the common indices on Rorschach and SIS-I. Deepak Kumar, Ph.D, Lecturer in Psychology, National College for Girls, Alwar (Rajasthan), Jagdish Kumar, Ph.D. Reader in Psychology, RBS College, Agra and *Rakesh Kumar, Ph.D., Senior Clinical Psychologist, Institute of Mental Health and Hospital, Agra. Email : pastlifeindia@yahoo.co.in (* Correspondence) Key Words: Rorschach, SIS-I, Mania, Depression.: Diagnostic Indicators

Material and Method : The sample consisted of 150 subjects in three groups - manic (n=50) and depressive (n=50) and normal (n=50). The patients were diagnosed as per the DSM-IV diagnostic criteria. The patients were selected from psychiatric facilities in Agra. The non-clinical control subjects were matched with the clinical group in terms of age, education and gender. The sample characteristics are shown in table-I. Both the tests - Rorschach and SIS-I were administered individually in one or two sessions depending on the situation and willingness of the participants. The scoring of the Rorschach protocols was done according to the system developed by Beck and associates (1961). The raw frequency of responses on each index (both on Rorschach and SIS-I) was transformed into percentage by dividing the frequency of each index by total number of responses produced on the total images or blots. This transformation was done to control the effect of variations in the productivity. Results and Discussion : The Rorschach protocols were scored for nine indices. The mean and standard deviation of transformed scores on each index was computed for the two clinical groups and the normal control group. To examine the significance of difference among the three groups t-test was performed. The obtained results have been presented in Table-2 and 3. Table 1 Sample Characteristics Characteristics Normal Manic Depressive (n=50) (n=50) (n=50) Gender Male Female Age 18-35 yrs 35 Above Education Up to 5th 5+ Domicile Rural Urban Results and Discussion : The Rorschach protocols were scored for nine indices. The mean and standard deviation of transformed scores on each index was computed for the two clinical groups and the normal control group. To examine the significance of difference among the three groups t-test was performed. The obtained results have been presented in Table-2 and 3. Examination of Table-1 reveals that the manic patients have scored lower than the normal subjects on all the indices except Poor Form, Anatomical and Rejection. Manic patients scored higher on Anatomical, Rejection and Poor Form indices. This pattern of difference was found to be statistically significant (Table-3). Comparison of depressives with normal revealed that depressive patients scored lower than normal subjects on total no. of responses, Human responses, Movement 54 Kumar et.al.

responses, popular responses and good Form responses and higher on Anatomical responses, rejection and poor Form responses. These two groups differed significantly on all the indices except Animal responses. Table 2 Mean & S.D. of Normal, Manic and Depressive Groups on Rorschach Characteristics Normal Manic Depressive (n=50) (n=50) (n=50) Total No. of Responses M 21.34 14.76 12.42 SD 4.17 3.72 2.74 Popular Responses M 17.95 14.26 13.39 SD 8.62 9.26 8.08 Good Form Responses M 63.11 50.66 37.59 SD 12.11 16.09 11.14 Poor Form Responses M 19.39 40.79 35.01 SD 11.92 14.81 10.86 Movement Responses M 7.90 3.08 1.90 SD 8.54 3.72 3.48 Human Responses M 8.24 9.11 5.20 SD 8.80 9.44 5.20 Anatomical Responses M 3.92 11.52 18.03 SD 4.79 13.31 10.16 Animal Responses M 26.26 23.47 27.80 SD 21.30 23.65 16.49 Rejection of Cards M 0.00 2.15 5.46 SD 0.00 5.42 7.42 Table 3 t-Value of Normal, Manic and Depressive Group on Rorschach Indices Normal Normal Manic Vs Manic Vs Depressive Vs Depressive Total No. of Responses 8.33* 12.63* 3.58* Popular Responses 2.05** 2.73* .50 Good Form Responses 4.37* 10.96* 4.72* Poor Form Responses 7.94* 6.83* 2.23** Movement Responses 3.64* 4.58* 1.63 Human Responses .47 2.37** 2.85* Anatomical Responses 3.79* 8.88* 2.75* Animal Responses .62 .40 1.06 Rejection of Cards 2.80* 5.21* 2.55** *significant at .01 Level **significant at .05 Level Diagnostic Indicators on SIS-I Rorschach 55

The comparison of both clinical groups revealed that manics were significantly different from depressives on all the indices except Animal responses, Movement responses and Popular responses. Manics scored significantly higher than depressives did on Total no. of responses, Human responses, good Form responses and poor Form responses. On the other hand, depressives scored significantly higher than manic patients did on Anatomical responses and Rejection (see Table2 & 3). The mean scores and SD on various SIS-I indices have been displayed in Table-4 and the between group comparisons using t-test have been reported in Table-5. Table 4 Mean & S.D. OF Normal, Manic and Depressive Groups on SIS-I Indices Normal Manic Depressive (N=50) (N=50) (N=50) Total No. Of Responses M 34.52 27.56 20.60 Sd 14.88 6.21 3.52 Most Typical Responses M 13.88 10.14 16.68 Sd 6.30 4.23 7.91 Typical Responses M 62.74 55.16 50.80 Sd 10.81 12.29 11.63 Atypical Responses M 24.17 34.69 32.05 Sd 13.64 12.42 13.13 Movement Responses M 4.49 1.21 2.51 Sd 5.39 2.66 3.83 Human Responses M 14.95 17.08 10.89 Sd 6.87 9.79 6.17 Anatomical Responses M 14.66 21.30 18.18 Sd 9.26 15.18 7.42 Animal Responses M 31.71 29.37 27.87 Sd 9.94 10.35 10.62 Rejection of Cards M .75 6.08 13.95 Sd 2.14 7.66 8.81 The comparison of SIS-I variables revealed that manics were significantly different from normal on all indices except Human responses and Animal responses. Manics scored significantly higher on Anatomical responses, Rejection and Atypical responses as compared to normal. On the other hand, the scores of manic patients were significantly lower than normal on Total no. of responses, Movement responses, Most Typical responses and Typical responses. Comparison of the mean scores of depressives and normal subjects indicate that both groups differed significantly on all indices except Animal responses and Most-typical responses. Depressives were significantly lower on Total no. of responses, Human responses, Movement responses and Typical responses as compared to normal. However, depressives scored significantly higher on Anatomical responses, Rejection and Atypical responses 56 Kumar et.al.

The comparison of both clinical groups revealed that manics were significantly different as compared to depressives on all indices except Animal responses, Anatomical responses, Typical responses and Atypical responses. Manic were significantly higher on Total no. of responses and Human responses from depressives. On the other hand depressives were significantly higher on Rejection, Movement and Most typical responses. Table 5 t-value of Normal, Manic and Depressive on SIS-I Indices Normal Normal Manic Vs Manic Vs Depressive Vs Depressive Total No. Of Responses 3.05* 6.43* 6.89* Most Typical Responses 3.48* 1.95 5.15* Typical Responses 3.27* 5.31* 1.82 Atypical Responses 4.03* 2.94* 1.03 Movement Responses 3.85* 2.11** 1.97** Human Responses 1.26 3.11* 3.78* Anatomical Responses 2.64* 2.33** 1,44 Animal Responses 1.15 1.86 .72 Rejection of Cards 4.73* 10.28* 4.76* *Significant At .01 Level **Significant At .05 Level The compatibility of the Rorschach and the SIS-I was evaluated by examining the correlation of sores on common indices of the two tests in the sample of normal subjects. Significant correlations were observed between the two tests on all the common indices except on Rejection and Anatomical responses. Table 6 Correlation Coefficient Between Common Indices of Rorschach & SIS-I Common Indices Normal (N=50) Total Number of Responses .57* Popular/ Most Typical Responses .45* Good Form/ Typical Responses .47* Poor Form/ Atypical Responses .68* Movement Responses .37* Human Responses .36* Anatomical Responses .23 n.s. Animal Responses .54* Rejection of Cards 0.00 *significant at .01 Level **significant at .05 Level Diagnostic Indicators on SIS-I Rorschach 57

Discussion : A comparison across groups revealed that manics produced significantly lower total responses (TR) as compared to normal subjects on Rorschach. Elevated mood, flight of ideas, and increased psychomotor activities is usually expected to produce above average TR in manics. Bohm (1958) Pratap & Kapur (1948), Kumar (1968) reported in their studies high TR in manic patients. The reasons of reduced productivity in manic patients in the index study are not apparent. The depressives produced lowest TR as compared to normal and manic groups, which is in expected direction. Depressives produced low TR due to slowed thought process, decreased psychomotor activities, loss of pleasure and depressed mood On SIS-I normal group produced an average of 34.52 responses. A comparison across groups revealed that both the clinical groups produced significantly low TR in comparison to normals but the depressives produced lowest TR reflecting similar trend on the SIS-I and the Rorschach. Both the clinical groups produced significantly lower popular responses. Moreover, manics and depressives did not differ significantly on this variable. The low popular responses in the clinical group are suggestive of their decreased ability to participate in group thinking. On SIS-I normal produced significantly higher MT responses compared to manics. But the depressive group on the other hand gave highest MT responses. While on Rorschach test both the clinical group had significantly lower popular responses. This finding needs further empirical exploration. Depressive and manic groups produced significantly lower Good form responses as compared to normals. Schafer (1948) reported that generally depressives produce higher good form responses but if Anatomy content is quite high in the protocol of such patients, than there is lowering of good Form responses. An examination of anatomy content in the index study revealed that the depressive patients produced highest association with the anatomy content. The preponderance of anatomy content in the protocols of depressive patients in the present sample perhaps resulted in lowered good form responses. On SIS-I both the clinical groups scored significantly lower on Typical responses compared to normal. Good form response on the Rorschach is comparable to Typical response on the SIS-I and both the clinical groups have also produced significantly low good form responses than normal. The clinical groups scored significantly lower Human Movement (M) than normal subjects on Rorschach test. However, manics and depressives did not differ significantly on this variable. Pratap & Kapur (1948) also observed significantly lower M in manics. Guirdham (1936) noticed that in depression there was a reduction in the appreciation of movement. This pattern of finding was also observed on the SIS-I. Normal and manics did not differ significantly on H responses. The depressive patients gave produced lowest Human content, as they tend to withdraw from social relations, consequently lowering down Human Content. 58 Kumar et.al.

SIS-I also shows similar trend on Human responses. A comparison across groups did not reveal any significant differences between normal and manics on this index. However, depressive group produced lowest H responses in comparison to normal and manic groups. This is a finding consistent with Rorschach and it demonstrates the diagnostic compatibility of this index. The comparison across groups revealed that both the clinical group produced significantly higher anatomical content than normal group. The depressive group produced highest anatomical responses. Sharma (2000) found very high prevalence of somatic symptoms in depressive patients. Because of high prevalence of somatic symptoms in depressives, these patients associated with greater number of anatomy responses. On SIS-I a comparison across groups revealed that compared to normals clinical groups were significantly higher on anatomical responses. But comparison between patients group did not yield significant differences. This finding is not in conformity with the results obtained on the rorschach test. The discrepancy once again needs to be explored in the nature of stimulus material. In SIS-I most of the stimulus has embedded anatomical parts, while images on Rorschach test are unstructured. This difference in stimulus material is responsible for an unequal trend across tests. A comparison of A% across groups suggested that manic and depressive patients did not differ significantly from the normals on this variable. However, in comparison to manic patients, the depressives produced higher animal content. Schafer (1948), Pershad & Parekh (2001), and Bohm (1958) incorporated high animal content in depressives as one of the diagnostic indices. The index study supported the finding of high animal content in depressives. On Animal responses, SIS-I was not found to be sufficiently sensitive to discriminate normal group from both the clinical groups. The Normal subjects did not reject cards why Manic and Depressive patients rejected more cards. Bohm (1958) reported that spontaneously or with a little persuasion depressive patients tend to associate with the test figures. The true rejection is usually seen in schizophrenics and organics. But in the face of overwhelming anxiety aroused in the depressed patients it may be difficult for them to associate at that particular time. Because of high anxiety and anergia in Dpressive patients more rejection might have been obtained. SIS-I also shows similar trend of image rejection. The depressive group has rejected highest figure than other groups. The above-mentioned similarities between the Rorschach and the SIS-I along with significant positive correlation between the various common indices of the two tests suggest that the SIS-I is capable of providing diagnostic information similar to the Rorschach. References : Beck, S.J. Beck, A.G. Levitt, E.E. and Molish, H.B. (1961). Rorschach Test Basic Processes. New York: Gurne&Strattons. Bohm,E. (1958) A Text Book in Rorschach Test Diagnosis.(Translated by A. Beck & S.J. Beck) New York: Grune &Stratton. Diagnostic Indicators on SIS-I Rorschach 59

Cassell, W.A.(1965). Body Perception and Symptom Location. Psychosomatic Medicine, 27, 172-176. Cassell, W.A. (1994). The Somatic Inkblot Series Continuing Rorschach Conceptualization. SIS Jr. Proj. Psy.& Ment.Health 1,3-14 Cinzia, S., and Roberto, F. (1998). The SIS-I and Body Image Evaluation in Subjects Suffering from Serious Obesity. SIS Jr. of Proj. Psy.&Mental Health, 5,105-113. Dubey, B.L. Mishra, M. Dwivedi, C.B. and Mishra, N.(1994). Diagnostic and Therapeutic Utility of Somatic Inkblot Series-II and Rorschach. SIS Jr. of Proj. Psy. & Mental Health, 1, 19-26. Guirdham, A. (1936). Simple Psychology Data in Melancholia, Jr. Ment. Sciences, 82,649-653. Khromov, A. (2001). Psychological Characteristics of Subject with Achondroplasia and Traumatically Shortened Extremities. SIS Jr. of Proj. Psy.&Mental Health, 8, 53-64. Kumar, P. (1960). The Rorschach Test in Manic and Normal Group. Indian Jr. of Psychology, 35, 35-38. Kumar, S. Singh, R. and Mohanty, S. (2001). A Study as Somatic Inkblot Series-I in Hospitalized Male Chronic Schizophrenic. SIS Jr. of Proj. Psy.& Mental Health,8, 31-37. Kumar, S. Mohanty, S. and Kumar, R. (2003). SIS-I Profile and its Correlation with Rorschach in Manic Patients. SIS-I Jr. of Proj. Psy. & Mental Health, 10, Mukhopadhyay, A. Benerjee, S. and Mitra, G.( 1996). A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS Jr. of Proj. Psy. & Mental Health, 3, 33-41. Pratap, S. and Kapur, M. (1984). Rorschach Study of Literate Manics. Indian Jr. of Clinical Psychology, 12, 29-34 Rathee, S.P. Goel, D.S. Chawla, M.L. Saldanha, D. and Dubey, B.L. (1994). A Study of SIS-I in Coronary Cases. SIS Jr. of Proj. Psy & Mental Health, 1, 51-64. Rathee, S.P. and Singh, A. (1995). A Comparative Study of Male and Female on SIS-I. SIS Jr. of Proj.Psy. & Mental Health,3,43-49. Saldanha, D. (2000). Profile of Militants: An Attempt to Study the Mind of Militant. SIS-I Jr. of Proj. Psy. & Mental Health, 9, 23-32. Schafer, R.(1948). The Clinical Application of Psychological Tests. New York: International Universities Press. Sharma, S. (2000). Somatization in Endogenous Depression. Behavioral Scientists, 1, 43-49. 60 Kumar et.al.

Rorschach Inkblot Test in India : Historical Review and Perspectives for Future Action L. Sam S. Manickam and B.L. Dubey Rorschach test has been in use in India since 1947 and the volume of research studies revealed that the test is being used with diverse population. Different scoring systems were followed and the review of the studies indicated its popular use with clinical population. However, there was no major and in-depth study undertaken on its adaptation or improvising the scoring pattern, or comparison of different scoring methods. With the introduction of the Somatic Inkblot Series, a projective test available in different forms including the video series, there is increased research on SIS compared to Rorschach test. Though the studies suggested the usefulness of the test in aiding diagnosis, understanding psychopathology and helping in therapy, the declining research interest on the test impels to revitalise the training and research of the test in India. Efforts across the country may be pooled in to develop norms for different indices including the content signs for Caste and Religion wise, Culturally, Ethnically and Linguistically Diverse (CARCEALD) Indian population. The Rorschach Inkblot test that was developed in 1921(Rorschach, 1951) is the oldest and the most popular projective test in India and it is widely used in clinical setting (Dubey, 1981; Kohli and Kaur, 2002; Verma and Misra, 2002). Projective techniques had been in use in India with diverse clinical population for the assessment of perception, psychopathology, diagnosis and therapy. Among the projective tests, the Rorschach test is extensively used since it is found to be a tool to unearth the deep-rooted emotional conflicts that are not manifested as overt behaviour (Verma, & Misra, 2002). Verma (1980) reported that fifty percent of inpatient referrals and twenty percent of outpatient referrals to the clinical psychologists, from the department of psychiatry at Chandigarh were meant for differential diagnosis and Rorschach test was invariably administered for differential diagnosis. Diagnostic testing remained the most demanded function of clinical psychologists in psychiatric set ups or hospitals and Rorschach test was administered in majority of the cases referred for differential diagnosis (Arora, 1982; Dubey, et. al., 1981; Verma & Misra, 2002). In the initial phase of the introduction of the test in India, in the fifties and sixties, research papers related to Rorschach test were published mainly in Indian Journal of Psychology and Indian Journal of Psychiatry. At present, primarily there are three journals published from India- Indian Journal of Clinical Psychology, (1974), Journal of Personality and Clinical Studies (1985) and SIS Journal of Projective Psychology and Mental Health (1993) that published articles related to Rorschach test and projective psychology. With the publication of Journals of psychology devoted to clinical area, articles related to projective psychology and clinical psychology found place in these Journals. In these three Journals the number of articles published using Rorschach test as a research tool showed a decreasing trend in the last decade of publication. After the introduction of the Somatic Inkblot Series, a projective test with different versions, including the Video Series and CD (Cassell, 1980; Cassell & Dubey, 2003; L. Sam Manickam, Ph.D. Professor Dept. of Cl.Psychology, SR Med. College and Res. Inst. Porur, Chennai - 600116 (India) Tel : 91-044-24765512, Cell : 91-9447009032 E-mail : sammanickam@sify.com and B. L. Dubey, Ph.D., DPM, FSIS, Director SIS Centre P.O. Box 1107, Sector 15 P.O. Chandigarh-160015 E-mail : sisdubey@rediffmail.com Key Words: Rorschach, India, SIS, projective tests, CARCEALD population

Dubey, 2003) and the publication of the SIS Journal of Projective Psychology and Mental Health from 1993, publication of research related to projective psychology in India increased. However, the research interest on Rorschach test appears to be diminishing based on the percentage of articles published in the same journal over the last ten years. Though publication in these three journals can be considered as a pointer to the trend in research with the Rorschach test, there are a number of research studies that are conducted in different centres of training that go unpublished. This could be due to the paucity of the appropriate journals, accessibility of the journals and/or the lack of enthusiasm on the part of the concerned research student to complete the process of publication. Moreover in India there is no funding agency, that promotes the research exclusively in the areas of clinical psychology or psychology and lack of financial funding has thwarted the publication zeal of researchers (Manickam, 2003). The present paper reviews the studies conducted in India using the Rorschach Inkblot test since its introduction in the country. The article aims to provide historical perspective on the use of the test in India, the application of the test in diverse settings, the scoring methods followed, the different groups of population on which research was conducted, salient findings, use with different clinical population including therapy, research on the test itself, consistency of the responses and future perspectives. History of Rorschach Test in India : The Rorschach test was introduced in India probably in the pre-independence period and the earliest published work appeared in 1947 (Prasad and Asthana, 1947). Some earlier reviewers (Bhargava & Saxena, 1995) of the test have opined that Dosajh (1956) and Jain (1956) being the pioneers in using the tool for research in India. The study of Prasad and Asthana (1947) was an experimental one from a ‘general psychology perspective’ where in they looked into the signs of meaning on Rorschach test. However H.S. Asthana continued his research with Rorschach test and published papers in scientific Journals and presented papers both in India and abroad in the fifties and early sixties (see references). Asthana’s work spanned more than two decades and he administered the test to diverse groups, developed norms for Indian population (Asthana 1950a, 1950b and 1971) and described the personality of social organisation of Indians using the tool (Asthana, 1956). His work on the perceptual development of children (Asthana, 1965, 1966) led to the publication of the report that looked into the scope of the Rorschach test as a research tool to study the perceptual framework of children (Asthana and Mohan, 1977). Another early research that went unnoticed by earlier reviewers is the work of Ray (1955) who used the test with tribal population. Along with Dosajh (1956) and Jain (1956), Bagh (1955) had also used the test with adolescent school children, almost half century ago. The other earliest publications include that of Gupta, (1959), Julka (1963), Raychaudhari and Maitra (1965a) and all the studies were conducted on diverse student population in altered settings. Probably Asthana (1963) was the first Indian researcher to use the Rorschach test for research in clinical settings and brought out its clinical utility in assessing different aspects of personality (Bhargava & Saxena, 1995). Since then, clinicians in hospital and clinical settings had been using the test. With the introduction of the Diploma in Medical Psychology (DMP; later titled as D.M.&S.P. and M.M.&S.P, currently M. Phil in 62 Manickam

Clinical Psychology) at the All India Institute of Mental Health (presently National Institute of Mental Health And Neuro Sciences, NIMHANS), Bangalore, India in 1955, Rorschach was introduced to the students of clinical psychology. And now the test forms part of the curriculum of the clinical psychology trainees at the six training centres in India. Moreover, the master level students who select a course in clinical psychology are also given training in administration and glimpse of the interpretation of the test. In the history of the use of the test in India, at different periods of time one or two researchers persisted with their interest and piloted administering the test as a research tool. While Asthana from the start in 1947 led the scene in fifties and sixties, Raychaudhari and Kumar carried the baton in sixties and early seventies and it was taken over by Dubey in the seventies and eighties (see references). S.K. Verma and D. Pershad also contributed much in keeping the test active in research for more than three decades. However, in the late nineties and in the beginning of the twenty first century, the research interest appeared to have decreased though more clinicians continue to use the tool for assessment purposes. Shukla (1977) reviewed the test from a wider perspective of the projective techniques in India and Dubey, et. al., (1981, 1982), appraised the status of the test in the eighties in an earlier review. Scoring Systems : Though different scoring systems were developed in other countries, no effort has been made so far to develop a scoring system that may be applicable to the Indian population. Also, there is no consensus regarding the scoring system to be followed by the clinicians in India. Probably this reflected the philosophy of clinical training, where focus is on the clinical use of the test rather than on the research utility of the Rorschach test. Comprehensive System and its computerised scoring system (Exner, 1995; Exner, 2001) were not used in any of the six major training centres in the country except little work in RINPAS Ranchi. The published papers showed that, Klopfer’s Method (Klopfer, & Davidson, 1962) being used by researchers (Banerjee et. al., 1998) and Exner’s Methods were also used, with more preference to Klopfer’s method. Beck’s (Beck, & Molish, 1967) scoring system was also used (Kumar & Patel 1990; Kohli and Kaur, 2002). Some researchers used the specific signs like the Piotrowski’s organic signs in Rorschach among epileptics (Vagrecha and Sen, 1974) or the Theisens’ Pattern on psychotic disorders (Chaudhury & Sundari (1996). Piotrowski’s alpha diagnostic formula and its clinical utility was yet another area of investigation (Prabhu, 1970). The oldest and one of the major training centres of clinical psychology is the department of clinical psychology at the National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore and the Rorschach test forms part of the curriculum. The scoring method taught at this institute was based on the manual developed by Arthur De Vos (De Vos, 1973), which is closely related to the Klopfer’s method. Since this scoring method was not followed elsewhere, the data collected using this method, could not be compared with the research findings from other centres. However, research students who use the test as a research tool got trained in one of the established scoring system for analysis of the research data and Klopfer’s method was the preferred one (Kaur and Kapur, 1983; Pratap and Kapur, 1984; Ramachandra, 1994). Pershad and Pareekh (2001) prepared a protocol manual for the test. Though the authors specified that the objective of the manual was to popularise the test using the ‘ made it easy manual’, the scoring approach it had taken may confuse the students Rorschach in India 63

since it does not adhere to any particular scoring system nor had tried to develop a scoring system based on Indian experience. However it has taken into consideration the diverse population of India in relation to some of the indices and content. Different Groups : The test was used with diverse groups of Indian population. At the time of introduction of the test in India, the test was widely used with student population in educational setting (Bagh, 1955; Dosajh, 1956; Jain, 1956; Gupta, 1959; Julka 1963; and Raychaudhari & Maitra, 1965a) and later it was used with the clinical population (Asthana, 1963). Epilepsy and Mental Retardation : In clinical situation, Rorschach was used with epileptic patients in neurological setting at a very early period in the seventies. After that there were no efforts to explore the use of the test from a neurological setting. Somasundaram, et. al., (1971a) explored the utility of the test in patients with epilepsy. Somasundaram, et. al., (1971b) also studied the popular responses of patients with epilepsy. Other studies that involved patients with epilepsy were conducted around the same period (Vagrecha & Majumdar, 1974). Vagrecha and Majumdar (1975) evaluated the diagnostic usefulness of Piotrowski’s signs in Rorschach responses of epileptic patients. Interestingly, the test was used with persons with mental retardation too (Upadhyaya & Sinha, 1974; Ojha, 1975). Physical Illness : Though the test was used with people with different physical illness in the initial period, it was not used later with the physically or psycho somatically ill population for research. This could be due to the fact that the clinicians who worked in the medical or general hospital setting were less in number. Even the low number of professionals who worked in medical set ups might have other professional functions as their priority that dissuaded them from exploring the worth of the test. Moreover, psychological intervention for patients with different physical illnesses are not given due importance in the medical setting by other specialists. Therefore, there might have been less referral to the psychologists for evaluation that led to the less output in research with the test from medical setting. Ardhapurkar, et. al., (1967; 1974) and Dutta, et. al., (1976) evaluated the Rorschach responses of patients with physical illness. Ardhapurkar, et. al., (1967) evaluated the profile of patients with ischaemic heart disease. Ardhapurkar, et. al., (1974) in another study appraised the Rorschach test responses of patients with bronchial asthma and Dutta, et. al., (1976) investigated patients with peptic ulcer. Children and Adolescents : Even in the early stages of the introduction of the test, Bagh (1955) using the test researched adolescent school children. Asthana, (1965; 1966) evaluated the perceptual development of children and Julka (1962) also conducted research with child population. Using the indices of aggression and maladjustment Raychaudhuri, et. al., (1969) compared the normal boys and boys with behavioural problems. Dixit (1964) conducted a developmental study of the response pattern of children and adolescents. Joseph and Pillai (1986) differentiated the creative students into high and low creative group using certain indices. Bhargava and Saxena (1995) studied the deprived group of adolescents and Prakash (1977) reported the profile of institutionalised orphan children. Shankar (1956) and Raychaudhuri & Maitra (1965a) also examined the 64 Manickam

responses of the young offenders. Shanmugam, (1969) correlated yet another interesting variable, the lunar signs (stars) and the responses of adolescents. Though there were diverse and exciting experiments with the test on children in the initial phase, there were not many innovative attempts in the later period. Based on the experience of using the test with different groups of children, Asthana and Mohan (1977) recommended the scope of the Rorschach test as a research tool to study the percept of children more than three decades ago; but there were not many takers for it. Psychiatric Disorders : Though the test was used with general population initially, more number of studies emerged from hospital patients who were diagnosed as having psychotic disorder or neurotic disorder (Mishra and Dwivedi, 1997). More often the Rorschach test was administered to patients who attended the psychiatry out patient department to undifferentiated groups of patients (Kohli and Kaur, 2002) for either establishing a diagnosis or differential diagnosis. Probably P. Kumar (see references) was one of the early researchers other than B.L. Dubey (see references) to have done extensive work using Rorschach test with the clinical population. Kumar evaluated the profile of the patients with different psychiatric disorders, and compared it with the normal control group. Among psychotic disorders, Kumar (1961b) investigated the profile of patients with schizophrenia, and verified the differences with that of a normal control group (Kumar, 1963). Bagadia, et. al., (1971) on a large sample analysed the responses of patients with schizophrenia disorder. Dubey, (1977) and Dubey, et. al., (1977) studied the psychiatric population, focusing on schizophrenia and compared it with neurotic and other disorders. Mujtaba and Mujtaba, (1985) and Prasad, et. al., (1987) also evaluated the groups of patients with schizophrenia and other disorders. Deviating from the common trend, Malaviya (1973) studied the Rorschach signs of suicide on a group of schizophrenic patients who had attempted suicide. Exclusive research on patients with affective disorder was undertaken by Kumar (1960b) and provided a profile of the patients with mania, and compared it with a control group (Kumar, 1965). Similarly he also analysed the profile of patients with depressive disorder (Kumar, 1962b) and compared it with a normal control group (Kumar, 1962a). Almost a decade later, Bagadia, et. al.,(1973) on a large sample described the profile of patients with depressive disorder. Pratap and Kapur (1984) studied patients with mania and more recently Kumar, et. al., (2003) compared the Rorschach test and SIS-I indices of the manic patients. Kumar (1960a) studied the response profile of the test of patients with different neurotic disorders and compared it with general population (Kumar, 1961a). While Dubey, et al., (1979) studied the patients with neurotics disorder, Akhtar, et al., (1975) studied the patients with obsessive-compulsive disorder. Ramachandra, (1994) compared the profile of a group of patients with neurotic disorder with that of creative artists and noncreative group. Sexual Disorders : Probably Kapur and Kapur (1967) had pioneered the evaluation of the profile of patients with sexual disorder. Though Rorschach has diagnostic indicators of sexual dysfunction, only Dubey (1977) has later used the tool to assess the signs and evaluated its usefulness Rorschach in India 65

in therapy. Raychaudhuri and Mukherjee (1970) explored the Wheeler and Shafer signs of homosexuality in male prisoners. Prison Population : Early as well as later studies focused on prison population. As early as in 1956 Shanker (1956) appraised the profile of juvenile delinquents. Raychaudhuri and Maitra (1965a) compared normal convicted and incipient delinquent adolescents. Mukherjee, (1965, 1966, 1968) conducted a series of studies on different groups of prison population. Majumdar and Mukherjee (1969) examined some of the ratios of the Rorschach test profile of the prisoners who were convicted and Sharma, (1969) compared the colour pyramid and the responses on Rorschach test of recidivists. Raychaudhuri and Mukherjee (1970) explored the homosexuality signs of Rorschach test indices. But Sethi, et. al., (1971) appraised the psychopathology of murderers using the test. On the other hand, Yadav (1977) described the profile of prisoners who were convicted for rape, decoity and murder. Miscellaneous Groups and Indices : Dubey (1979, 1981) conducted several research studies on military personnel both clinical and normal population (Dubey and Dosajh, 1979; Dubey, 1981). He also studied, executives in different set ups (Dubey, 1988; 1989). While Hussain, et. al., (1976) appraised the profile of unwed mothers, Kumar and Patel (1990) compared the profile of martially high and low adjusted women. Creativity is another significant area that has been looked into. Raychaudhuri and Maitra (1968) examined the level of creativity using the movement responses of Rorschach and found significant association. Raychaudhuri, (1971) in another study explored the correlation of creativity and gender. Ramachandra, (1994) compared the indices of creative artists, neurotics and non-creative group. Interestingly even at the beginning phase of introduction of the test, Raychaudhuri (1963) studied the responses of the Indian musicians. Hostility and aggression as measured through the test was also subjected to enquiry (Shivadasani, 1971; Rangaswami, 1982;Gupta, et. al., 1989). Julka (1962) Kundu (1969) and Singh (1975) appraised the profile of tribal population. Kundu (1969) described the response pattern of tribal young offenders and Singh (1975) studied the effect of modernisation on the response pattern of the tribal population. Probably, Malaviya’s (1973) research is the only contribution towards understanding the signs of suicide on the Rorschach test. Findings on the Rorschach Test : A comprehensive compilation of the findings is beyond the scope of this article. However some of the key and salient observations are mentioned here to generate more inquiry of the studies conducted so far and to initiate further research. Norms : Dubey and Dosajh (1979) found that the average response was 14 (13.76) among army personal serving in other ranks but Kumar (1962c), Prabhu, (1967), Asthana (1971) and Somasundaram, et. al., (1971b) found that the average number of responses for the normal population was in the range of 18-33. Singh (1975) also found that the number of responses given by tribal population that had more ‘culture contact’ and 66 Manickam

‘less culture contact’ was below the normal range reported from abroad. Singh (1975) opined that the group he studied were “not perceptually responsive and not receptive” to the world outside and gave less number of popular responses. Human responses (H) accounted for 9.66 percent (Singh 1975) and it was contradictory to the findings reported by Prabhu (1967) and Kumar (1962c), but was in agreement with the report of Asthana (1971) and Somasundaram, et. al., (1971b) that found H in the range of 7 to 10 percent. Mental Retardation : In one of the earliest studies on clinical population, Upadhyaya, & Sinha, (1974) administered the test to mentally retarded adults with high and low intelligence (IQ above and below 40). The lower IQ group showed more descriptive themes, poor verbal productivity, less interaction, perceived environment as more threatening, gave less shading and colour responses, had lower mean range of content and less popular responses on Rorschach. Vagrecha, & Sen, (1974) studied patients with epilepsy and found the use of 5 or more signs on Rorschach Test to be of lesser relevance for organic group than the Piotrowski’s findings. Schizophrenia : Dwivedi, et. al., (1995) found that schizophrenics gave less number of responses and more responses with anatomy and sex content. In a study on 25 active schizophrenics and 25 recovered cases, Sandhu (1978) observed that the recovered schizophrenics showed improvement in the form level, reality orientation, emotional control and decline in anatomy content. Pershad et. al., (1979) evaluated the profile of ‘the difficult to diagnose cases’ and found that 26.5% gave at least one of the pathagnomonic signs that Brar, (1970) suggested-namely, loosening of association, tendency to overgeneralise, lack of reality contact and pursuit of one’s or personal meaning to common symbols. When taken separately 20% of the protocols had one or more responses of confabulation, 11% had contamination and 6% had position responses. Dubey, (1977) also found signs on Rorschach that differentiated patients with schizophrenic disorder, neurotic disorder normal group. Dubey, et.al., (1977) compared the over inclusive thinking patients with different psychiatric disorders. Prasad, et. al., (1987) compared patients with obsessive-compulsive disorder with that of schizophrenics. Mujtaba and Mujtaba, (1985) studied 20 Wheeler’s signs of homosexuality of paranoid and non-paranoid schizophrenic patients. Though both the groups had the homosexuality signs, the paranoid group had significantly higher number of the signs. While the paranoid group had 9.4 signs, the non-paranoid had only 4.15, as listed by Wheeler. But the presence of homosexuality signs, they suggested, may not be taken as the ‘sign’ to diagnosis individual cases. Prasadrao, et. al.(1987) compared obsessive compulsive disorder and schizophrenia and signs that differentiated the group were W%; D%; P; F+%; R; Anatomy; Sex and M:C. Sandhu (1978) compared Rorschach test responses of patients with schizophrenia disorder and those who have recovered from the disorder. Though location and movement determinants could not differentiate between the two groups, the recovered patients showed indices suggestive of reality orientation, emotional control and decline in anatomical contents. Rorschach in India 67

Affective Disorder : Pratap and Kapur (1984) studied hospitalised patients with manic disorder and found that the group had increased indices like total number of responses, responses on cards VIII, IX and X, reaction time to achromatic cards, average response time, location details and determinants compared to a control group of normal subjects. Content responses and popular responses as well as F+ and F- Form level ratings differed significantly in the two groups. Substance Abuse : Rorschach test could differentiate alcoholics from non-alcoholics. Arora, (1982) observed that on 6 categories, namely, +C>3, M<C, Water responses, Fabulized responses>1, F%<65% and W%<20, differentiated alcoholics from non alcoholics. Similarly, Banerjee et. al., (1998) examined seven indices of the test- Human, Animal (A), Anatomical, Atypical, Popular (P), Rejection (R) and Sex (S) responses of heroin addicts using Klopfer’s method. Out of that, four indices namely, A, P, R and S significantly discriminated the heroin addicts from the control group. Prison Population : Yadav, (1977) observed that the Rorschach protocol of criminals convicted for rape, decoity and murder were under productive, rejected more cards, showed casual interest to test situation, gave few movement, W and P responses and low intellectual efficacy of responses. Rangaswami, (1982) studied the hostility measure of the test on three groups of prison population and found that the hostility measure on Rorschach was positively correlated to the hostility measure of the Hospital Hostility Questionnaire. The test could differentiate the three groups of convicts who were diagnosed to be schizophrenics, non-convicts who were schizophrenics and control group that consisted of persons with no psychiatric disorder. Anxiety Disorders (Neuroses) : Ramachandra, (1994) studied 30 creative artists, and equal number of neurotics and non-creative group, using Klopfer’s method. The creative group had average number of responses, quick reaction time, and healthy emotional relationship with others and good ego strength. The experimental group of creative artists had the ability to view their problems objectively and incisively as evidenced by the indices. However the quality of responses suggested a keen perception and disposition to do things differently from that of the other two groups. Kaur and Kapur (1983) using Klopfer’s method studied patient group with conversion and dissociative disorder (hysterical neurosis). The experimental group of patients with ‘hysteria’ gave fewer responses, took more time, and gave more d and less S responses. The percentage of Fc, FC’, C’F and FC were low compared to the normal group. The content analysis showed that the group gave more responses with mythological human responses, animals, nature, clouds, sex and unusual responses than the normal group. Gupta, (1977) used Rorschach ranking conformity test and found no correlation between normal subjects and a group of patients with neurotic disorder. But the study had a small sample size of 25 in each group. Other Groups : Using the hostility measure on Rorschach test, Singh, & Kapur, (1984) studied 150 school children in the age group of 11-14 years and found association with locus of 68 Manickam

control, intelligence and PEN scores. Bhargava & Saxena (1995) examined the profile of deprived group of adolescents and they found that the group differed from the control group on longer RT, RT chromatic and achromatic cards. Kumar and Patel (1990) found that the Rorschach test differentiated high marital adjusted and low adjusted women. The highly adjusted group gave more average number of response (28.73), whereas the lower group gave only 18.60. The RT as well as TR was less for highly adjusted group. However the study was conducted only on a sample of 15 each and the low adjusted group was not screened for the psychiatric status. Usefulness in Diagnosis : Kohli and Kaur, (2002). Administered Rorschach and PEN to 125 patients attending the psychiatry department of the Post Graduate Institute of Medical Education and Research, Chandigarh (India). Cases were referred to Psychology Unit for ruling out psychotic illness. The variables of the questionnaire did not show any significant correlation with Rorschach indices. The Rorschach profile showed signs of general disturbances and propensity to psychosis rather than clear-cut pathognomic signs. Mishra & Dwivedi, (1997) compared the diagnostic indices of Rorschach on a sample that comprised of 50 normal subjects, 50 neurotics and 50 schizophrenics. The Rorschach test indices discriminated the normal subjects and paranoid schizophrenics. However the Rorschach indices better discriminated patients with depressive disorder (neurotic depression) and undifferentiated schizophrenic patients. How far the research findings observed on Rorschach test is helpful in understanding a patient or patients in clinical situation is a pertinent question. Though there are research reports on various indices in diverse patient population, to what level the indices can be considered significant is still a perturbing question for the Indian clinician. A careful analysis of the available research findings from different corners of the country and an expert compilation of the research data may prove handy. The compiled report may also help initiate a well-planned and co-coordinated multi-centred research of the Indian population using the test. Test Improvising : Research on improving the scoring methods or evaluation of studies related to the test has not been undertaken. One exception is the critique of Pershad and Dubey (1977) that was published more than a quarter century ago on the productivity of the test and it’s scoring. In order to study the productivity on Rorschach protocol, they suggested the need to differentiate between low, medium and high number of responses from homogenous group for research comparison than focusing on low and high number of responses. Dubey (1985) analysed the discriminating capacity of the test regulating the number of responses and Dubey and Pershad (1978b) controlled the responses of the test to observe the shift in clinical significance. Apart from these, there are no other attempts made to improve upon the use of the test either as a research tool or as a clinical aid. Consistency and Validation : A comprehensive test- retest is not reported with one exception. Dubey, et. al., (1994) administered the Rorschach test to a client before and after 6 months period and Rorschach in India 69

reported consistency of 4 responses on two cards, card IV and VI, and slight change in two other cards. Mathur and Pais (1963) correlated the ‘extratensive’ and ‘introtensive balance experience’ as measured by Rorschach test with that of the scores on Sack’s Sentence Completion Test. Raychaudhuri and Maitra (1965b) attempted to validate the test using the development stages and Rorschach indices. Raychaudhuri and Mukherjee (1969) also tried to validate movement responses based on expression of agitated impulsivity. Mukherjee. and Raychaudhuri (1970) evaluated the correlation between the Rorschach indices and structured measures of personality with the clinical rating. Pratap and Filella (1966) in an early attempt explored the correlation between the test indices and the scores on manifest anxiety scale. Banerjee, et. al. (1998) investigated the significance of the salient features of SIS measure with that of the subtle and common indices of the Rorschach test. However their objective was to validate SIS indices rather than that of the Rorschach test. Therapeutic Use : There are not many studies that looked into the therapeutic usefulness of the test, though clinicians tend to make use of the findings of the test for selection of patients for psychotherapy or setting the limits in psychotherapy. However, Cassell and Dubey, (1996) narrated the usefulness of the test in releasing somatised grief. Rorschach Test – the Current Scenario : In the initial phase of the test in India, studies focused on general population, especially students. After realising its potential with the clinical population the number of studies using the test with the normal population diminished except for the assessment of the normal subjects as control group. However, Singh and Kapur, (1984) used the test with 150 school children in the age group of 11-14 years to correlate the Rorschach measure of hostility scores with that of locus of control, intelligence and PEN scores. Mishra & Dwivedi, (1997) compared the diagnostic indices of the SIS-II with the Rorschach test in normal subjects but the objective was to study the indices of the SIS II and was not meant to validate the indices for Rorschach. Kaur & Verma, (1998) administered Rorschach test and SIS-II to 32 psychiatric patients in order to assess the inter-relations on selected variables. Both the scales showed some degree of overlap with significant correlation between the two scales on Movement, Human, Animal and Popular responses (r= ranging between 42 to 58) but insignificant correlations for Anatomy, sex, F+ and Total response. In India, as stated earlier, the recent studies using the tool compared the SIS projective test and Rorschach test. Mishra & Dwivedi, (1997) compared the diagnostic indices of the SIS-II with the Rorschach test in Normals, Neurotics and Schizophrenics on a sample that comprised of 50 normal subjects, 50 neurotics and 50 schizophrenics. The results suggested that the diagnostic confidence certainly which is achieved by the SIS II and the Rorschach in diagnosing the neurotics and schizophrenics compares well. The study further suggested that both the tests provided support to the theory that SIS-II provides certain additional diagnostic information that are not available through the Rorschach. The results also suggested that the SIS – II indices as compared with that of Rorschach test, discriminated the normal subjects and paranoid schizophrenics. However, the Rorschach indices could discriminate the depressive neurotics and undifferentiated schizophrenics. 70 Manickam

Reviewing the studies conducted on different groups it appeared that some of the research was conducted due to the easy accessibility of the sample rather than answering or exploring a pertinent research question. However Rorschach test continues to be used as a tool for personality assessment and diagnosis of different types of mental disorders (Kohli, & Kaur, 2002; Verma, & Misra, (2002). Future Perspectives : 1. Norms for Caste and Religion wise, Culturally, Ethnically and Linguistically Diverse (CARCEALD) Indian population : The diversity of the Indian population requires no special mention. The Caste and Religion wise, Culturally, Ethnically and Linguistically Diverse (CARCEALD) Indian population is too complex and cumbersome for a psychologist to work with (Manickam, 2004). It may be an unattainable task in the near future to develop norms even for the more commonly used tests than the projective test. And unlike other measurement tools, developing norms for projective tests is not an easy task, especially for the CARCEALD Indian population. Though Rorschach test stimulus can be considered culture free, the response pattern is influenced by culture. Singh (1975) reported the difference in the responses of tribal population from two types of culture contact area. Administering the test to 100 tribal population of Gadeba living at Karapat, in Orissa State to two groups, one with more culture contact and the other with least culture contact, the number of responses given by both the groups was observed to be below the average. The content of the responses also showed significant diversity. D’Netto et. al., (1974) found the average response of the army personnel to be 16+(-) 6.5 and it is significantly lower than Kolpfer’s- 20-45 and that of Prabhu (1967) (28.5 + (-) 9.71). Hence there is a great need for developing norms for the CARCEALD population. However several clinicians and other researchers have attempted to develop “Indian” norms of Rorschach responses. The earliest attempt was by Asthana (1950b) and he also (Asthana 1950a; 1963; 1971) provided norms for groups of population. Somasundaram, (1964) attempted to develop norms for the population in Kerala. Prabhu (1967) also provided norms of some of the indices for the adult population. Several studies focused on reporting norms of specific indices rather than that of the complete profile. Jain and Prakash (1967) explored the linear correlation between Sum R and other indices in order to establish norms and Kumar (1962c) listed the popular responses on Rorschach for different groups of population. Apart from the findings referred above, several other studies used samples of general population as control group. But no concerted effort had gone in to pool in the data that would give sample size enough to draw statistically significant conclusions. Training in Comprehensive System (Guarnaccia, et. al., 2001) may also help ease the burden of clinicians by resorting to computerised analysis of the profile and easy compilation of the data from across the country Manickam (2003) observed that the research psychologists in India refrained from communicating with each other about their research and shy away from publishing the research findings and that resulted in much wastage of the research done on CARCEALD population in India. 2. Content Analysis : Though different authors studied the response patterns, indices and the profile, systematic research on content analyses is yet to be undertaken. Content wise, D’Netto Rorschach in India 71

et. al., (1974) observed that military personnel gave responses related to military environment. In clinical situation, the ‘content’ of the responses do influence in formulating the differential diagnosis and is of much assistance to predict the outcome of psychotherapy and its prognosis. Though there are manuals available based on the findings abroad, studies from CARCEALD Indian population is negligible. Clinicians depend on the content analysis provided by the researchers abroad. Responses like Xmas father (Card II), Xmas tree Card VIII, cross, (Card VI) vampire (Card I, IV, V) court of alms (Card VIII) ‘after math of September 11’ (Card IX) responses are given by subjects who are Hindus by faith and hailed from urban, multi religious background. Subjects from Christian and Islamic faith orientation also gave responses like ‘temple tower’ (Card II) and ‘lamp that is used in temples’ (Card II, Card VII). One exception is that of Tripathi and Julka (1960). However, a comprehensive and consolidated report is yet to be developed on this clinically valuable variable. With computerised scoring system and analysis, it might be much more easier to conduct studies on content analysis. A multi-centred study to elicit the content profile of both clinical and nonclinical CARCEALD Indian population may be initiated. 3. Profile of Children and Adolescents : It is surprising to observe that the tool in its early stage of entry into the research in India in the 1950’s focused on exploring different variables related to different groups of children. But the same momentum was not found in the later part of the last century. Moreover, research related to the child and adolescent clinical population also appears to be a significant omission. With more researchers focusing on child population in India and the diagnostic categories had undergone sea change over the last couple of decades, it would more useful for the clinicians to have the Rorschach profile of clinical child population in India. 4. Profile of Disadvantaged Population : The tool was used with the different groups of population- normal subjects, different diagnostic groups, age groups and other special groups including tribal group. However, only Shanker (1968) explored the caste factor, other than that of the tribal group. Shanker (1968) investigated the correlation between the educational level and the affective factors on Rorschach among Dalits (Harijans). In ‘CERALD’ population, it would be worth investigating the precepts of different caste groups. 5. Assimilation of Data : One of the ways to improve the data bank on Rorschach test is to encourage the research students or a faculty member at the training centres to assimilate the Rorschach test profile of the psychometric case records that are submitted to the department as part of the training. A considerable amount of data on Rorschach test that are supervised by an experienced faculty member are available and it is easy to compile the data and develop at least one report from each centre a year. The compiled report from six centres could provide a good data source for refining the understanding of the Indian ‘psyche’. 6. Resource Book on the Rorschach Test : Books were published exclusively on Rorschach Inkblot from India. The earliest book on the test was ‘Rorschach Psychodiagnostic. An Indian case study’. (Kundu, 1980). 72 Manickam

Dubey (1982) compiled his extensive work and other contributions and brought out the book, ‘.A Pragmatic view of Rorschach Ink Blot Technique’ . ‘Rorschach Test: Theory and Practice’ (Mishra et. al., 1996) is yet another book. The latest one was ‘A protocol manual for the Rorschach Test’ (Pershad & Pareekh, (2001). Comprehensive review of contributions of several researchers across the country could bring out a resource book on different diagnostic categories of psychiatric patients that would be a valuable source for the students, clinicians and researchers. Professional associations and/or institutions could take the lead to this venture to make the effort comprehensive and more meaningful to the CARCEALD context. Conclusion : It may appear paradoxical to observe that the research related to the test flourished till clinical psychologists “took over” it and after that it showed a declining trend. One of the factors for this phenomenon may be the attraction of young clinical psychologists towards the emerging science of neuro psychology and behavioural intervention strategies within the ambit of clinical psychology in India. This led to side lining of psychodynamic psychology and to the “unconscious” rejection of the psychodynamic process of the clients. With that the projective tests altogether and Rorschach test in particular slipped into a dormant phase. It is also likely that with the introduction of SIS, clinicians and researchers prefer to use SIS, which is less complicated and found more useful than the Rorschach test (Cassell et.al. 2001, 2003; Cassell and Dubey 2003, 2004; Dubey et. al., 1994). Clinical psychologists in practice are using the test but research output from the clinicians is very minimal. The practicing clinicians may be encouraged to publish case reports on the clinical utility of the test similar to those articles published on SIS (Cassell, et. al., 2000; Manickam & Suhani, 2003; Manickam, et. al., 2004). Whether the Rorschach test would remain a ‘blot’ in the repertoire of the researchers in India while clinicians continue to use it with the ‘traditional flavour’ or it would generate more research in understanding the different psychodynamic factors and help identify the pathognomic signs of different groups of the CARCEALD population depends on more concerted effort from the fraternity of psychologists in India. References: Akhtar, S., Pershad, D. and Verma, S.K. (1975). A Rorschach Study of Obsessional Neurosis. Ind. J. of Clini. Psy. 2: 139-143. Ardhapurkar, I., Mehta, Z. and De Souza, A. (1967). Rorschach in Ischaemic Heart Disease. Ind. J. of Psychi. 9:260-263. Ardhapurkar, I., Mehta, Z. and De Souza, A. (1974). Rorschach Protocols in Cases of Bronchial Asthma. Clinician, 37:292-295. Arora, U. (1982). A Rorschach Study of Alcoholics. Ind. J. of Clini. Psy. 9: 141-145. Asthana, H.S. (1950a). Historical and Experimental Approach to the Problem of Personality. Unpublished Doctoral Dissertation Submitted to University of Lucknow, Lucknow. Asthana, H.S. (1950b). Indian Norms of Rorschach Responses. Ind. J. of Neuro. & Psychi. 2: 10-18. Asthana, H.S. (1956). Some Aspect of Personality Structuring in Indian (Hindu) Social Organization. J. of Soci. Psycho. 44: 155-163. Asthana, H.S. (1963). A Rorschach Study of Indians. Rorschachiana, 45: 283-286. Rorschach in India 73

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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. 300/- & Life Membership Rs. 2500/- Institutional Membership Rs. (600/-) Institutional Life Membership (Rs. 4000/-) Total Cheque $/Rs._______________Drawn at_________________________________ Signature of applicant : _______________________________ Date :________________ PLEASE RETURN with your cheque to : B.L. Dubey, Ph.D., 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-II Images in CD, SIS-I Videotape and SIS-Living Images A Walk Through The Garden of Life and many more, Audio & Videotapes SIS Journal of Projective Psychology & Mental Health in C D (Acrobat and Page Maker) from Volume 1-12 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

5th International Conference of Somatic Inkblot Society, Cochin (Kerala, India) November 26-28, 2004. The 5th International Conference of Somatic Inkblot Society was jointly organized by School of Behavioral Sciences M.G. University, Kottayam and Somatic Inkblot Society at Hotel Circle Manor, Kaloor, Cochin (India) from November 26-28, 2004. Dr.(Mrs) Jancy James, Vice Chancellor M.G.University, Kottayam was the chief guest inaugurated the conference. His holiness Swami Poornamrithananda Puri of Amrithanandamayi Math, Hon. Minister Dominic Presentation, Prof. Razeena Padmam Director, School of Behavioral Sciences, M.G.University graced the occasion. The SIS is an international, non-profit scientific organization with its head office in Anchorage, Alaska (USA). 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 purpose of the conference was 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. About 200 international and Indian Psychologists, Psychiatrist and students of Psychology participated in the conference. Research papers in the areas of projective psychology, personality assessment, diagnostic evaluation, Attention Deficit Hyperactivity Disorder, HIV, alcoholics, physically challenged, cardiac patients, asthmatics, stutters, autism, learning disability, psychotherapy, stress management, multiple intelligence, aging gracefully, psychiatric rehabilitation and mental health, were presented in the conference. A workshop on the application of Somatic inkblot series was organized by Dr.B.L.Dubey. 3 invited papers were presented on : ‘Multiple Intelligence’ by Dr. Philip John, Consultant Psychiatrist, Peejay’s Policlinic, Ernakulam, ‘Graceful Aging’ by Dr. Mathew Abraham, Consultant Neurologist, Lakshmi Hospital and ‘Rehabilitation in India’ by Dr. T Murali, Consultant Psychiatrist, NIMHANS, Bangalore. The best paper SIS research award was given to Prakash Chandran, Ph.D., Rakesh Pandey, Ph.D.,Rakesh Kumar, Ph.D., Deepak Kumar, Ph.D., Ruchi Jain, Ph.D., Anand Dubey, M.B.A. Nalini Mishra, Ph.D. and S.N.Dubey, Ph.D. The ‘Krishnakuamri Memorial Young Scientist Award’ was given to Mr. Biji Mathew, Research Scholar, Dept. of Psychology, University of Calicut by Dr. Ajit Bhaskar, Chief Psychiatrist and Director, Dhanya Nursing Home, Palarivattom, Cochin. The venue of the 6th SIS International conference is being explored. Members of Somatic Inkblot Society, interested in inviting the 6th conference are requested to contact Dr.B.L.Dubey on email : sisdubey@rediffmail.com. Dr. Prakash Chandran Prof. B L Dubey, Ph.D. Chairman Org. Committee President, Somatic Inkblot Society 5th SIS International Conference, P.O.Box. 1107, Sec.-15 Post Office, Dhanya Nursing Home, Chandigarh-160015(India) M.K.K.Nair Road, Palarivattom, Email: sisdubey@rediffmail.com Edappally.P.O., Kochin - 682 024 (India) Mobile: 91-94170-36655 Email: prakasharackal@rediffmail.com Tel: 91-172-2710986 Mob.: 91-98470-39971 Tel: 91-484-2536709

SOMATIC INKBLOT SOCIETY is an International organization. It is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH a half yearly publication in January and July. It has 2 Awards of $250 employing the use of Inkblot Tests SIS & Rorschach. For details please contact : Wilfred A. Cassell, M.D., FAPA, APC, FSIS, Director, Somatic Inkblot Center, Editor in Chief, 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, FSIS, President Somatic Inkblot Society, 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 APPEAL Members of Somatic Inkblot Society are requested to kindly sent their Annual dues before the 31st of January each year to enable the society to meet its expenses and smooth publication of SIS Journal of Projective Psychology and Mental Health Editor in Chief

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 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 : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Ave. Anchorage, AK 99516 (USA). E-Mail: siscassell@yahoo.com EDITORS : B.L. Dubey, Ph.D., Director SIS Center India, Post Box 1107, Sector 15 Post Office, Chandigarh-160 015 Tel.: 91-172-2710986, Mob.: 91-94170-36655, E-mail: sisdubey@rediffmail.com : Anil Agrawal, BE, MBA, C.E.O,Telephone Cables Ltd., 68-70, Sector 17-C,Chandigarh E-mail : aagarwal33@yahoo.com : Prakash Chandran,Ph.D. Dhanya Nursing Home, Palarivattom, Edappally P.O. Kochin-682024 (Kerala) Tel.: 91-484-2536709 Mob.: 91-9847039971 Email: prakasharackal@rediffmail.com : Anand Dubey,B.E., MBA, SIS Center, 4406 Forest Road, Anchorage, AK 99517 (USA) E-Mail: adubey@hotmail.com : Padma Dwivedi, M.A., Medical Social Worker, Dept. of Cardiology, Post Grad. Medical Institute, Chandigarh Mob.: 91-94170-36655 : L. Sam Manickam, Ph.D. Professor Dept. of Cl.Psychology, SRMC and RI, Porur, Chennai-600116 (India) Tel: 91-044-24765512, Cell:91-9447009032 E-mail : sammanickam@sify.com : Rakesh Pandey, Ph.D. Reader, Dept. of Psy., M.G.Kashi Vidya Peeth, Varanasi-221001. Tel.: 91-542-2318246 E-mail : rpan_in@yahoo.com : Tamera Randolph, PO Box 244045, Anchorage, AK 99524 (USA) E-mail: tamerarandolph@hotmail.com : Amool Ranjan Singh, Ph.D. Prof.,RINPAS,Kanke,Ranchi-834006. Tel.:91-651-2233687E-mail:dr_amoll_r_singh@rediffmail.com : Col. Rajinder Singh, 1526, Sector 34-D, Chandigarh, Tel. : 91-172-601398 (H) (LM 98) Mob.: 9815728220 Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi John Baby, Ph.D., India Phillip W. Baker, Ed.D., U.S.A. Mahesh Bhargava, Ph.D., India D.K. Bhatt, B.E., India S. Chaudhury, MD, Ph.D., India Alfred Collins, Ph.D., U.S.A. Carina Coulacoglou, Ph.D., Greece Philip Greenway, Ph.D, Australia Somesh Gupta, M.D., India Anuradha Jatana, M.A., 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 R.N. Singh, Ph.D., India David Sperbeck, Ph.D., U.S.A. Ajay K.Srivastava, Ph.D., India Ramjee Srivastava, Ph.D., India Ailo Uhinki, Ps.D., Finland P.K. Vasudeva, Ph.D, India Uma Vasudeva, D.H.A. India Yasho V. Verma, Ph.D., India