SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 12 Number 2 July, 2005 SIS ISSN 0971 - 6610 Vol. 12, No. 2, Pgs. 85-160 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 (double-spaced throughout) submitted in duplicate to B.L. Dubey, Ph.D. Editor, SIS Journal, 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 "SIS Journal of Projective Psychology and Mental Health" and should reach Dr. Nalini Mishra, General Secretary, Plot No. 196, Saket Nagar, Naria, Varanasi-221 005. Please add $5./Rs.60/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society / journal members should inform B.L. Dubey Ph.D, Director SIS Center, Email : sisdubey@rediffmail.com and Foreign Members should inform Mr.Anand Dubey, Editor, 4406 Forest Road, Anchorage, AK-99517 (U.S.A.) Email : adubey@hotmail.com Tel : (907) 248-2256, 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 2, July 2005 Contents Page Nos. 1. Editorial: Evidence Based Medicine and the SIS, Wilfred A. Cassell 2. The Relationship Between the Morbid Response 87-98 of the Rorschach Inkblot Test and Self-Reported Depressive Symptomatology, Edward M. Petrosky 3. Assessing Suicidal/Homicidal Impulses with the SIS, 99-106 Wilfred A. Cassell 4. Who’s Afraid of Rorschach Inkblots? Projective Studies 107-114 in India an End Century Assessment, Nilanjana Sanyal, Manisha Dasgupta and Mohor Mala Chatterjee 5. Diagnostic Efficiency of Schizophrenia Index and 115-122 Perceptual-Thinking Index in Schizophrenia and Mania, Ranjeet Kumar and C.R.J. Khess 6. An Extended Scoring System of SIS-I, 123-128 Rakesh Kumar 7. A Comparative Cognitive Profile of Epileptic and 129-140 Non-Epileptic Normal Preadolescents, Nilanjana Sanyal and Nandhini Rajagopalan 8. SIS-I and Rorschach Diagnostic Indicators of Attention 141-152 Deficit and Hyperactivity Disorder, Ruchi Jain, Beer Singh, Sandhyarani Mohanty and Rakesh Kumar Effect of Psychological Intervention Through SIS-I 153-158 Images on Police Personnel, S.N. Dubey and B.L.Dubey

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 O R B. L. Dubey, Ph.D., DPM, FSIS, President Somatic Inkblot Society, Director Somatic Inkblot Center India, # 1671, Sector 49-B, PUSHPAC Society, Chandigarh 160047 (INDIA) Tele/Fax : 91-172-2634150, 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 Nalini Mishra, Ph.D., Secretary Plot No. 196, Saket Nagar, Naria Varanasi-221005 E-mail : sisdubey@yahoo.com Mob.: 91-9415814458

Editorial Evidence Based Medicine and the SIS We are now living in the 21st century when the concept of Evidence-Based Medicine is becoming internationally accepted. This is having a profound effect at all levels of research and clinical investigation. One definition of this follows: “Evidence-based medicine is looked upon as a new paradigm, replacing the traditional medical paradigm, which is based upon authority. It is based upon the use of randomized controlled trials, as well as systematic reviews (of a series of trials) and meta-analysis, although it is not restricted to these. There also is emphasis on the dissemination of information, as well as the collection, so that evidence can reach clinical practice. It therefore has commonality with the idea of research based practice”. In considering how these standards could be met in future scientific and clinical SIS work, certain issues need to be addressed. A central one concerns the highly subjective, unique and fluid aspects of IMAGERY. For a particular individual with focal somatic symptoms, in viewing SIS stimuli, organ images of that region may be sensitized at one moment, only to be perceptually inhibited seconds later. For such a person, the total number of anatomical responses depicting that area, could well be within the normal range, thereby complicating statistical analysis. Yet we must continue to come up with scoring systems and assessment procedures consistent with evidence-based standards. One approach, that has much appeal, involves brain imaging research designs employing the subject as his own control. An example would be an individual, who fails to detect anatomical structure in a highly structured SIS stimulus, yet perceives other stimuli in a normative fashion. Evaluating brain function under these two separate viewing conditions is methodologically feasible. Until we get neurobiologists and memory psychologists more involved in our work, we likely will find ourselves outside the halls of respectable science. We need to begin with the basics, such as the fact that neurons that process visual information look different structurally, than those for motor skills. Tracing centrally the multiple pathways of SIS stimulated sensory input and unraveling the neural systems for implicit memory, explicit memory, episodic memory and related affect underlying the projective released imagery poses challenges. On step in informing those outside our SIS society involves the SIS Journal of Projective Psychology and Mental Health. Thanks to the efforts of our Editor Dr B. L. Dubey, it is now available CD discs. These provide a new resource for reaching out to scientists internationally as well as providing information to supplement that available on our web site at http://www.somaticinkblots.com We all have encountered grandiose thinking and irreverent members of the human species, who frequently tend to overrate the power of science. Many fundamental issues of existence will likely prove beyond the reaches of understanding, by even the most intellectually endowed. Since we have the limitations of a homosapien’s brain, perhaps we will never be able to fully understand the human brain. Wilfred A. Cassell, MD, FAPA, APC, Editor in Chief SIS Journal and Director, SIS Center, 4501E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E-Mail: siscassell@yahoo.com

SOMATIC INKBLOT SOCIETY is publishing its Journal SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 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, E-mail : sisdubey@rediffmail.com E-mail : sisdubey@yahoo.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

The Relationship Between the Morbid Response of the Rorschach Inkblot Test and Self-Reported Depressive Symptomatology Edward M. Petrosky Self-report personality instruments have been conceptualized as indicating aspects of personality of which one is relatively aware. Thus, examining the relationships between Rorschach variables and self-report measures can expand the interpretation of Rorschach variables by indicating the conscious experiences associated with the variable in question. The present investigation attempted to determine the types of consciously experienced depressive symptomatology with which the Morbid (MOR) response is associated. The relationship between the number of MOR responses and scores on the Personality Assessment Inventory Depression subscales was examined using archival data from 49 adult psychiatric inpatients. The MOR response was not associated with self-reported affective, cognitive, or physiological depressive symptoms in isolation. However, as predicted, subjects who reported a disproportionately higher level of depressive affect compared to depressive cognitions produced more MOR responses. The converse was also true. Thus, an elevated number of MOR responses was associated with consciously experiencing a level of dysphoria beyond that which was represented cognitively. The author suggests that the MOR response may reflect ego-dystonic negative cognitions or individuals who are depressed but “trying not to think about it.” An important component of personality assessment is discerning the level of awareness a client has of different aspects of his or her personality functioning. In this vein, it is important to understand the extent to which assessment variables reflect conscious versus unconscious psychological processes. Consider for example a client who produces aggressive movement responses on the Rorschach. If the aggression was in an important component of personality assessment is discerning the level of awareness a client has of different aspects of his or her personality functioning. If the aggression was in the context of animal movement (FM), the client has aggressive ideation on the periphery of awareness. On the other hand, if the aggression was in the context of human movement (M) the client has a conscious conceptualization of him or herself as aggressive. In addition to FM and M responses indicating internal need states and self concept, respectively (Exner, 1991), they also signify the level of awareness the client has of these psychological phenomena. This distinction contributes to one’s understanding of the client’s personality functioning and informs treatment planning. The Rorschach and Minnesota Multiphasic Personality Inventory (MMPI)1 have been used in tandem for this purpose. Overall, research has failed to find significant correlations between Rorschach and MMPI variables that purport to measure the same construct (see for e.g. the review by Archer & Krishnamurthy, 1993). This has prompted the development of models of interpretation in which the Rorschach and MMPI are seen as tapping different levels of personality. Self-report measures, such as the MMPI, assess aspects of the client’s personality of which he or she is aware and willing to discuss (Acklin, 1993; Lovitt, 1993; Finn, 1996). In contrast, the Rorschach is a relatively unobtrusive measure that provides a behavioral sample of the client’s functioning (Lovitt, 1993), which yields information about the client’s personality Edward M. Petrosky, Department of Psychology, Iona College, 715 North Ave., New Rochelle, NY 10801 Key Words : Depressive Symptomatology and the Morbid Response.

organization (Acklin, 1993), of which the client may be unaware. Thus when juxtaposed, results from the two tests enable the clinician to compare how the client describes him or herself on the self report measure versus what he or she actually enacts on the Rorschach (Lovitt, 1993). Wiener (1993) emphasizes this distinction, but also notes that it is relative, not categorical. As illustrated above, the Rorschach variables span a continuum in terms of the degree of self awareness to which they correspond. Conversely, self-report measures can reveal information of which the client is unaware. Consider for example a client who, on the MMPI, elevates on the Hypochondriasis (1) and Hysteria (3) scales, and scores relatively lower on the Depression (2) scale. While aware of what he or she was endorsing on the individual items, this client, by endorsing this pattern of responses, has unwittingly revealed that he or she converts psychological distress in somatic complaints (Greene, 2000). Thus, both Rorschach and MMPI variables correspond to both conscious and unconscious psychological processes, the difference being that MMPI variables correspond mostly to conscious processes and the Rorschach variables correspond mostly to unconscious processes. Conceptualizing the Rorschach and MMPI as distinct, yet overlapping entities, enables one to utilize the inter-relationships between the two to enrich the interpretation of each (Nichols, 1996). In terms of the Rorschach, examining the relationships between Rorschach variables and self-report measures can expand the interpretation of Rorschach variables by indicating the conscious experiences associated with the variable in question The Morbid (MOR) response on the Rorschach, as defined in the Comprehensive System, is any response that is described by the subject as dead, damaged, injured or spoiled (e.g.s a bear that is hurt, a decaying leaf), or which has a dysphoric quality (e.g. an unhappy person) (Exner, 1993). The current interpretation of the MOR response is that it is associated with depressive symptomatology, specifically pessimism and a damaged self concept (Exner, 1993). The present investigation seeks to further develop the interpretation of the MOR response by determining the types of conscious experiences with which it is associated. Almost all of the empirical investigations involving the MOR response have been in the context of examining the Depression Index (DEPI) as a whole. To summarize, the research on the relationship between the DEPI and self-report measures of depression (Frueh, Leverett, and Kinder, 1995; Greenwald, 1997; Khouri and Greenway, 1996; Lipovsky, Finch, and Belter, 1989; Shapiro, Leifer, Martone, and Kassem, 1990) taken as a whole, have found almost an equal number of positive, neutral and negative relationships between the two. In terms of the research on the relationship between the MOR response specifically and self-report measures of depression, the number of studies is small. Lipovsky et al.’s (1989) study of 60 adolescent inpatients found moderate correlations between the number of MOR responses and the MMPI-2 Depression clinical scale and the Children’s Depression Inventory. Frueh et al.’s (1995) study of 20 adult PTSD subjects found fairly high correlations between the number MOR responses and the MMPI-2 Depression clinical scale and the F scale. Thus, two studies suggest a moderate to somewhat high association between the MOR response self-reported depressive symptomatology. However, these studies do not indicate which aspects of depressive experiences with which the MOR response is Petrosky

most associated, if any. This is underscored by the fact that the Depression clinical scale of the MMPI-2 is a heterogeneous scale sensitive to psychological distress other than specifically depression per se (Butcher, 1990; Greene, 2000), and the CDI may be more of a global measure of general distress (Lipovsky et al., 1989). The only study to the author’s knowledge that has attempted to clarify which components of self reported depression are most related to the MOR response was Khouri and Greenway’s (1996) study, which found that the number of MOR responses was not associated with scores on the Harris-Lingoes Depression subscales. The problem with this study, however, is that the Harris-Lingoes subscales are far from mutually exclusive and greatly overlap. Some of the subscales share many of the same items (Greene, 2000). For example, Greene (2000) notes that “all 10 items on the Brooding (D5) subscale also appear on the Subjective Depression (D1) subscale, and 12 of the 15 items on the Mental Dullness subscale are also on the Subjective Depression (D1) subscale” (p. 138). This is reflected conceptually in the overlap in interpretation of these subscales provided by Butcher (1990). For example, Butcher lists 5 descriptors of people who elevate on the Mental Dullness subscale, 4 of which are embedded in his list of descriptors for people who elevate on the Subjective Depression subscale.1 Like the MMPI-2, the Personality Assessment Inventory (PAI) is a broad based selfreport measure of psychopathology, designed with equal emphasis on both the conceptual and empirical adequacy of its items (Morey, 1991). The PAI subscales do not share items and are mutually exclusive. They were designed to measure discrete aspects of the construct measured by the clinical scales, and thus each has a distinct interpretation. Therefore, the PAI was chosen in the present investigation to assess which components of self-reported depression are associated with the MOR response. To date, no studies have examined the relationship between PAI and Rorschach variables. The 3 subscales of the Depression clinical scale on the PAI are the: Cognitive (DEP- C), Affective (DEP-A), and Physiological (DEP-P) subscales. The DEP-C subscale measures depressive cognitions, including Beck’s cognitive triad - that the self is worthless, the future is hopeless, and the present is overwhelming (Morey, 1996). The DEP-A subscale assesses depressive affective experiences, including sadness, anhedonia, and dissatisfaction with one’s life (Morey, 1996). The DEP-P subscale measures somatic manifestations of depression, such as appetite and sleep disturbance (Morey, 1996). The first purpose of this study was to examine the extent to which the 3 Depression subscales in isolation would be correlated with the MOR response. No a priori hypotheses were formulated for these analyses. Morey (1996) states that if DEP-C and DEP-P are elevated and DEP- A is relatively lower, the person is manifesting signs of depression, yet is repressing or suppressing sadness and / or is unable to label his or her affect. By extrapolation, the author argues that if a person elevates on DEP-P and DEP-A, and DEP-C is relatively lower, the person is experiencing depression affectively and somatically, but is suppressing or repressing depressive cognitions. That is, the person is depressed but “trying not to think about it.” If the person scores higher on DEP-A than DEP-C, this suggests the person but is experiencing dysphoria but is likewise suppressing or repressing depressive cognitions. At the least, in both instances the person is experiencing a level of depressive symptomatology beyond that which he or she is representing Depressive Symptomatology and the Morbid Response

cognitively. The inferential step that this disproportionately indicates a suppression of negative cognitions is not the only interpretation possible. However, even in the case of an biochemically induced depression or one precipitated by external stressors, the bi-directional relationship between thoughts and emotions suggests that once someone’s mood is depressed - for whatever reason - it pulls for concordant thinking. The research on mood dependent memory supports this point (Wilhite and Payne, 1992). Therefore, defense mechanisms notwithstanding, one would expect relative parity between one’s level of depressive affect and cognitions. When one finds a disproportional level of depressive affect compared to cognition, a viable interpretation that he or she is suppressing or otherwise avoiding depressive cognitions. Based on an informal analysis of several protocols the investigator had previously collected, he predicted that when a person is experiencing depressive symptomatology but suppressing depressive cognitions, he or she will have more of an “internal press” to express his or her negativity indirectly by projecting it onto the blot via the MOR response. The investigator predicted that subjects who produce relatively higher scores on DEP-A and DEP-P compared to DEP-C would produce more MOR responses than subjects for whom this was not the case. Specifically, the investigator predicted that, based on a median split: a) subjects producing relatively greater [(DEP-A) - (DEP C)] + [(DEP-P) - (DEP-C)] difference scores would produce more MOR responses than subjects who produced relatively smaller difference scores; and b) subjects producing relatively greater (DEP-A) - (DEP-C) difference scores would produce more MOR responses than subjects who produced relatively smaller difference scores. Method: Subjects: The sample consisted of 49 subjects, 30 male and 19 female, all of whom were inpatients on an acute psychiatric unit referred by their psychiatrist for psychological testing. The subjects’ age ranged from 19 - 63 years, with a mean and median of 35 and 34 years, respectively. Data was unavailable for 2 subjects’ ages, and for most of the subjects’ races. Nine examiners collected the testing protocols, including the investigator who collected 3 prior to the present investigation. All of the examiners were interns or practicum students in a doctoral program in clinical psychology, whose test administration and scoring of the data analyzed for the present experiment was closely supervised by a licensed clinical psychologist with extensive experience in psychological testing. The examiners collected a median of 3 protocols each. Exact information regarding the parameters surrounding subjects’ completion of psychological testing, including their emotional and cognitive state and diagnostic status is desirable yet was unavailable to the investigator. However, the investigator’s experience working in this setting (working in the same capacity as all of the examiners whose data was used in this study) allows the following informal characterization to be made of the population from which this sample was drawn. The author believes that one can extrapolate from this description to formulate a tentative picture of the likely characteristics of this sample. Clients on this unit are referred for psychological testing to assist in differential diagnosis. Usually, such clients’ presentation involves salient affective and psychotic features. Frequent referral questions include: differentiating between a primary affective versus psychotic disturbance, ruling out or quantifying the Petrosky

level of affective and / or psychotic symptomatology, assessing level of suicide risk, and ruling out malingering. In the author’s experience, clients are almost always tested within approximately 1 week of being admitted onto the unit and clients are virtually always taking psychotropic medication at the time of testing. The fact that all clients were admitted to an acute inpatient unit makes it safe to infer that they were demonstrating significant psychopathology in order to warrant admission. Thus, the present sample can be cautiously characterized as likely newly admitted psychiatric inpatients, on psychotropic medication, demonstrating salient affective and/or psychotic symptomatology, and for whom the precise nature of their disturbance was unknown to their psychiatrist. The use of exclusion criteria based on the PAI validity scales (described below) likely mitigated the presence of subjects who were malingering and especially those who had a cloudy sensorium at the time of testing. Design and Procedure: Archival data, from an acute inpatient psychiatric unit in an urban area, was reviewed for all inpatients receiving psychological testing during the years 1994 - 1999. Subjects were selected for potential inclusion if they had completed both the Rorschach and PAI. This yielded 115 potential candidates. Subjects were selected for inclusion if their PAI validity scale scores fell within parameters set for this study, and if their Rorschach protocols met Exner’s (1995) validity criterion of having at least 14 responses. The Rorschach was administered according to the standardized administration procedures of the Comprehensive System (Exner, 1995). Because the data was not originally collected as part of a formal study, inter-rater reliability data for Rorschach scoring is not available. However, all Rorschachs were scored by graduate students with extensive didactic training in the Rorschach Comprehensive System under the direct supervision of a licensed psychologist with extensive experience administering, scoring, and interpreting the Rorschach. The PAI contains 4 validity scales the: Inconsistency (INC), Infrequency (INF), Negative Impression Management (NIM), and Positive Impression Management (PIM) scales. The INC scale contains 10 pairs of items with related content, and reflects the degree to which the subject responded to items in a consistent fashion (Morey, 1991). The INF scale contains items that are answered similarly by mostly all subjects, and thus provides an indice of whether or not the subject attended to the items when responding (Morey, 1991). That is, the INF indicates if the subject actually read the items. The NIM scale reflects the degree to which the subject presented an extremely negative picture of him or herself suggestive of either malingering, severe psychopathology, or a “cry for help” (Morey, 1991). The PIM scale indicates the degree to which the subject presented a very favorable image of him or herself, denying even minor faults (Morey, 1991). Prior to the examining subjects’ scores on these variables, cut-off values for inclusion were established for each of the validity scales based on Morey’s (1991) interpretations and practical considerations by the investigator geared towards maximizing N without sacrificing validity. Subjects were excluded if their scores on any of the validity scales were equal to or exceeded the following: 69T for INC, 62T for INF, 101T for NIM, and 68T for PIM. The INF scale was given the most stringent cut off value since the most crucial validity check is to ensure that subjects actually read the test items in the first place. Its cut off was set at the low end of the “moderate” range of scale elevation Depressive Symptomatology and the Morbid Response

(Morey, 1991). More leeway was given for the INC scale since a certain amount of inconsistency in responding can be expected by virtue of subjects’ psychopathology. This cut-off value was set towards the middle of the “moderate” range of scale elevation (Morey, 1991). The cut-off value for the PIM scale was set at the beginning of the “high” range of scale elevation (Morey, 1991) so that subjects in the entire moderate range would be included. A moderate degree of positive impression management is acceptable for this study since some of the hypotheses predict a certain amount of suppression of symptoms. Finally, the NIM scale was given the most generous cut off since the base rate of this scale in an inpatient setting can be expected to be high. Its value was set initially at 101T. However, it was found that reducing the cut off to the more conservative value of 92T - the beginning of what is considered the “high range” (Morey, 1991) - would only eliminate 5 subjects. Therefore, the cut off for NIM was reset to 92T to make the cut off more consistent with interpretive norms. Although the number of MOR responses may give the appearance of a ratio variable, and has been treated in past research this way, it is most appropriately conceptualized as an ordinal variable because the assumption of equal intervals is not met. For example, one would not say that someone who has 2 Morbid responses feels twice as damaged or is twice as pessimistic as someone with 1 Morbid response. This is consistent with Exner’s Comprehensive System (1991, 1993, 1995) in which the number of MOR responses is interpreted according to critical cut off values. Therefore, in this study the MOR response was treated as an ordinal variable. Spearman rho correlations were performed between the number of MOR responses subjects produced and each of their T scores on DEP-A, DEP-C, and DEP-P. Because no a priori hypotheses were formulated for these correlations, these comparisons were two tailed. To examine the hypothesis that subjects with relatively greater [(DEP-A) - (DEP-C)] + [(DEP-P) - (DEP-C)] difference scores would produce more MOR responses, the following was conducted. Subjects’ T scores on DEP-C were subtracted from their T scores on DEP-A and from DEP-P. The difference between both of these computations was summed into a single difference score. Subjects were divided into high and low difference groups based on a median split of these difference scores. The group comprising the upper half of the split was labeled High Difference Group 1, and the group comprising the lower half of the split was labeled Low Difference Group 1. Thus, High Difference Group 1 was characterized by subjects with high DEP-A and DEP-P scores compared to DEP-C scores. Low Difference Group 1 was characterized by subjects with high DEP-C scores compared to DEP-A and DEP-P scores. To examine the hypothesis that subjects producing relatively greater (DEP-A) - (DEP-C) difference scores would produce more MOR responses, subjects’ T scores on DEP-C were subtracted from their T scores on DEP-A to produce a difference score. Subjects were divided into high and low difference groups in the same fashion as described above, except the groups were labeled High Difference Group 2 and Low Difference Group 2. One tailed Mann-Whitney U tests were performed to test each of these hypotheses. All p values cited below for the post hoc comparisons regarding High and Low Difference Group 2 are one tailed unless otherwise noted. Results and Discussion: Petrosky

Descriptive statistics for the PAI Depression subscales were as follows, with all values rounded to the nearest whole number: for DEP-A, M = 68, SD = 18, range = 39 – 102; for DEP-C, M = 66, SD = 20, range = 37 – 107; for DEP-P, M = 63, SD = 14, range = 38 – 94. All 3 Depression subscales were normally distributed, with the values for both skewness and kurtosis being < 1 for all 3 of the subscales. The MOR response had a M = 1.69 with a SD of 2.20 and a range of 0 – 14. The MOR response was “severely” (Curran, West, and Finch, 1996) non-normally distributed with skewness = 3.77 and kurtosis = 20.16. This supports the author’s use of non-parametric comparisons in the present investigation. The first difference score, [(DEP-A) - (DEP-C)] + [(DEP-P) - (DEP-C)], yielded a M of -00.33 with a SD of 26.18 and a range of –68.00 to +50.00 The second difference score, (DEP-A) - (DEP-C), yielded a M of 2.24, with a SD of 12.85 and a range of -27.00 to +37.00 Both of these scores were normally distributed with skewness and kurtosis both < 1. Spearman rho correlations between DEP-C, DEP-A, and DEP-P and number of MOR responses were all non-significant, at .12 (p = .41); .23 (p = .11); and .04 (p = .80), respectively. A weak trend was observed with regard to DEP-A, whose correlation coefficient was notably higher than the other two. In conclusion, there was a weak, though non-statistically significant trend for self reported affective symptoms of depression to be associated with the MOR response, and there was no relationship between self reported cognitive or physiological symptoms of depression and the MOR response. On a side note, DEP-A was highly correlated with DEP-C (r = .77, p < .000), which supports the author’s statement above that one typically would expect a relative parity between one’s level of depressive affect and cognitions. In the predicted direction, High Difference Group 1 (n = 23; M rank = 26.54) produced more MOR responses than Low Difference Group 1 (n = 24; M rank = 21.56). However, this difference was not statistically significant (U = 217.5; p = .10). As predicted, High Difference Group 2 (n = 24; M rank = 27.23) produced significantly more MOR responses than Low Difference Group 2 (n = 23; M rank 20.63; U = 198.5; p = .045). Eliminating DEP-P in the second comparison and examining the level of MOR response production in subjects with a high discrepancy between only DEP-A and DEP-C increased the difference between the high and low difference groups to one of statistical significance. This suggests that the difference observed between High Difference Group 1 and Low Difference Group 1 can be better accounted for simply by the discrepancy between DEP-A and DEP-C, independent of DEP-P. This is also a more parsimonious explanation. Thus, the hypothesis that subjects producing a large [(DEP- A) - (DEP C)] + [(DEP-P) - (DEP-C)] discrepancy will produce more MOR responses was not supported and should be dropped in favor of the second hypothesis, which was supported: that subjects producing a large (DEP-A) - (DEP-C) discrepancy will produce more MOR responses than subjects without such a discrepancy. In summary, the present investigation found that subjects who reported relatively more affective than cognitive depression produced significantly more MOR responses. For the sake of brevity, for the remainder of the article High Difference Group 2 and Low Difference Group 2 will be referred to simply as the High and Low Difference Group, respectively. As might be expected, by placing subjects who produced higher DEP-A than DEP-C scores in the High Difference Group, the mean DEP-A score alone was Depressive Symptomatology and the Morbid Response

higher for the High Difference Group (M = 70T) than for Low Difference Group (M = 66T) and the mean DEP-C score was lower for the High Difference Group (M = 58) than for the Low Difference Group 2 (M = 74). An independent samples t-test indicated that the difference in DEP-A scores between the High and Low Difference Groups was not significant (t (45) = .734, two tailed p = .467). However, to challenge the interpretation that it was the discrepancy between DEP-A and DEP-C that explained the difference in MOR production across the High and Low Difference Groups, it was determined if subjects simply high on DEP-A (defined by a median split), independent of their scores on DEP-C, would produce more MOR responses than subjects low on DEP-A. The weak correlational trend noted above between DEP-A and number of MOR responses further warranted such an examination. It was found that subjects whose DEP-A score was above the sample median for DEP-A (n = 24; M rank = 27.25) did produce significantly more MOR responses than subjects below the median on DEP-A (n = 23; M rank = 20.61; U = 198.00; p = .044). It was also found that the High and Low Difference Groups differed significantly in terms of mean DEP-C score (t(45) = -3.055, two tailed p = .004). Thus, two rival explanations to rule out are that the difference in number of MOR responses across the High and Low Difference Groups found above could have been accounted for simply by high scores on DEP-A or low scores on DEP- C alone. The following post-hoc analyses were conducted to examine these rival explanations. Two comparisons were conducted, one with subjects matched on DEP- A and the other with subjects matched on DEP-C, to determine if subjects in the High Difference Group would still show more MOR responses even with the two groups equal on DEP-A and then on DEP-C. Subjects were matched on DEP-A in the following manner. Firstly, subjects from the High and Low Difference Groups with the exact same values on DEP-A were included. In cases where there were more subjects in one group with a given value than in the other group (e.g. one subject from the High Difference Group had a value of 80T and 3 subjects in Low Difference Group had a value of 80T), one subject from the group with multiple subjects with the same value was randomly selected. All random selections were conducted using a random table of numbers from Runyon and Haber (1991). This process yielded 28 subjects, 14 from each group. The remainder of subjects were then matched and included if they differed by no more than 5 DEP-A points from a subject in the opposite Difference group. This was accomplished as follows. Subjects in the High and Low Difference Group were rank ordered in their respective groups from highest to lowest based on DEP-A score. In cases where more than one subject within a given group had the same DEP-A score, such subjects were randomly selected to take precedence over the other subject(s) with the same value. For example, two subjects in the High Difference Group had DEP-A scores of 83. One of these two subjects was randomly selected to go before the other subject on the rank ordered list. Then, beginning with the first subject, and proceeding in order down the list, it was determined if there was any subject in the Low Difference Group who had a DEP-A score within 5T score points (in either direction) from the first subject in the High Difference Group. If so, both subjects were included. Subjects for whom a counter-part could not be found in this manner were excluded from this analysis. This resulted in 10 additional subjects, 5 per Group, being included, increasing the total number of subjects for this comparison to 38, 19 per group. This resulted in the High Difference Group and the Low Difference Group having almost exactly the same values on DEP-A (High Difference Group M = 69.05, Low Difference Group M = 67.89), the difference between the two Groups being non-significant (t(36) Petrosky

= .188; two tailed p = .852). The High and Low Difference Groups, now matched on DEP-A, were compared again in terms of MOR response production. Consistent with the initial comparison, the High Difference Group (M rank = 23.05) produced significantly more MOR responses than the Low Difference Group (M rank = 15.95; U = 113.00.; p = .022). Subjects were also matched on DEP-C scores in exactly the same manner as was performed to match subjects on DEP-A scores, and re-compared in terms of MOR response production. This procedure resulted in a total of 22 subjects, 11 per group. Twenty of these subjects were matched based on the exact value of DEP-C. The other pair of subjects were matched based on having DEP-C scores within 5 T score points of each other. The High and Low Difference Groups had virtually identical scores on DEP-C (High Difference Group M = 58.27; Low Difference Group M = 58.45), the difference between the two groups being nonsignificant (t(20) = -.027; two tailed p = .979). The High and Low Difference Groups, now matched on DEP-C, were compared again in terms of MOR response production. Consistent with the initial comparison, the High Difference Group (M rank = 15.18) produced significantly more MOR responses than the Low Difference Group (M rank = 7.82; U = 20.00; p = .003). It is of note that the comparisons using matched subjects were robust against the lower power created by the reduced N for these comparisons, especially with regard to the comparison in which subjects were matched on DEP-C. Figure 1. Figure 2. ÿþÿ ÿþþÿ þþÿ þþÿ þ Median number of MOR responses as a function of DEP-A score and Difference Group. Depressive Symptomatology and the Morbid Response

Median number of MOR responses as a function of DEP-C score and Difference Group. Finally, and perhaps most illustrative, Figures 1 and 2 illustrate the median number of MOR responses produced by the High and Low Difference Groups according to whether subjects’ scores on DEP-A and DEP-C, respectively, fell in the lower, middle, or upper third of the DEP-A and DEP-C distributions. Figure 1 shows that the High Difference Group produced a median of 1 additional MOR response than the Low Difference Group across each third of the DEP-A distribution. Thus, subjects whose DEP-A score was high relative to their score on DEP-C produced more MOR responses, independent of the magnitude of DEP-A alone. Additionally, the most MOR responses for both the High and Low Difference Groups came from subjects whose DEP-A score was in the middle third of the DEP-A distribution, indicating that it is not the case that the number of MOR responses increases as DEP-A scores increase. Figure 2 demonstrates that subjects in the High Difference Group produced an almost identical number of MOR responses across each third of the DEP-C distribution. In addition, the Low Difference Group produced more MOR responses in the upper third of the DEP-C distribution than the lower third. Thus, it is not the case that the number of MOR responses increases as DEP-C score decreases. In addition, although the High and Low Difference Groups produced a similar number of MOR responses in the upper third of the DEP-C distribution, the High Difference Group produced a median on 1 and 2 additional MOR responses than the Low Difference Group across the lower and middle thirds of the DEP-C distribution, respectively. This would not be expected if the number of MOR responses increases purely as a function of low DEP-C scores in isolation. In conclusion then, the difference in MOR responses between the High and Low Difference Groups found above cannot be accounted for by the values of DEP-A or DEP-C in isolation. In order to arrive at a more thorough understanding of the results, the investigator also examined the number of MOR responses that best differentiated the High and Low difference groups, as well as the relationship between the two variables from the ÿþÿ ÿþþÿ þþÿ þþÿ 96 Petrosky

reverse perspective - the average (DEP-A) - (DEP-C) score associated with given elevations on the MOR response. It appears that 3 or more MOR responses best differentiates the High and Low Difference Group. This finding is consistent with the Comprehensive System in that 3 or more MOR responses is the cut-off value for interpretive significance in terms of both the DEPI and for indicating the presence of a pessimistic set (Exner, 1991). Of the 11 subjects who produced 3 or more MOR responses, 82% (9) were in the High Difference Group. In addition, these 11 subjects yielded a mean (DEP-A) - (DEP-C) score of 9.13, indicating that, on average, subjects who produced at least 3 MOR responses produced a DEP-A score almost 1 SD greater than their DEP-C score. In contrast, the 38 remaining subjects produced an average (DEP-A) - (DEP-C) score of only .24, the difference between the two groups of subjects being statistically significant (t (47) = -2.105, p (two-tailed) = .02). Conversely, of the 14 subjects whose DEP-A score was at least 1 SD (i.e. 10 T score points) greater than their DEP-C score, 50% (7) produced 3 or more MOR responses. In contrast, only 12% (3 of 26) of subjects whose DEP-A and DEP-C scores were within 1 SD of each other, and only 11% (1 of 9) of subjects whose DEP-C score was at least 1 SD greater than their DEP-A score, produced 3 or more MOR responses. Conclusions: Subjects who reported relatively more depressive affect than depressive cognitions produced more MOR responses. Specifically, a large disparity in self reported depressive affect over depressive cognitions was associated with having produced at least 3 MOR responses and conversely having produced at least 3 MOR responses was associated with a large disparity in self reported depressive affect over depressive cognitions. Thus, an elevated number of MOR responses (defined as at least 3) was associated with consciously experiencing a level of dysphoria beyond that which was represented cognitively. That is, such individuals may be depressed but “trying not to think about it.” Taking a further inferential step, the author suggests an elevated number of MOR response may indicate ego-dystonic depressive cognitions. The above finding also could be interpreted more generally as indicating that the MOR response is associated with externalized negativity. That is, the person redirects self-devaluing thoughts onto external stimuli. This explanation is consistent with Morey’s (1996) discussion of a higher DEP-A than DEP-C score. Morey alludes to the fact that these subjects tend to attribute their unhappiness to external factors. In closing, the results of this study await replication. In the interim, the results suggest that if a client produces 3 or more MOR responses, the clinician might benefit from exploring if the client has a disproportionately higher level of affective over cognitive depressive symptomatology. References: Acklin, M. W. (1993). Integrating the Rorschach and the MMPI in clinical assessment: Conceptual and methodological issues. Journal of Personality Assessment, 60 (1), 125-131. Archer, R. P., & Krishnamurthy, R. (1993). Combining the Rorschach and the MMPI in the assessment of adolescents. Journal of Personality Assessment, 60 (1), 132-140. Butcher, J. N. (1990). MMPI-2 in psychological treatment. New York: Oxford University Press. Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16- 29. Exner, J. E. (1991). The Rorschach: A Comprehensive System volume 2: Interpretation (2nd Depressive Symptomatology and the Morbid Response

ed.). New York: John Wiley & Sons. Exner, J. E. (1993). The Rorschach: A Comprehensive System Volume 1: basic foundations (3rd ed.). New York: John Wiley & Sons. Exner, J. E. (1995). A Rorschach workbook for the Comprehensive System. Asheville, NC: Rorschach Workshops. Finn, S. E. (1996). Assessment feedback integrating MMPI-2 and Rorschach findings. Journal of Personality Assessment, 67 (3), 543-557. Frueh, C. B., Leverett, P. J., and Kinder, B. N. (1995). Interrelationship between MMPI-2 and Rorschach variables in a sample of Vietnam veterans with PTSD. Journal of Personality Assessment, 64 (2), 312-318. Greene, R. L. (2000). The MMPI-2 An interpretive manual (2nd Ed.). Needham Heights, MA: Allyn & Bacon Greenwald, D. F. (1997). Comparisons between the Rorschach Depression Index and depressionrelated measures in a nonpatient sample. Psychological Reports, 80, 1151-1154. Khouri, S. & Greenway, P. A. (1996). Exner’s Depression Index and the Harris-Lingoes MMPI-2 subscales for depression. Perceptual and Motor Skills, 82, 27-30. Lipovsky, J. A., Finch, A. J., & Belter, R. W. (1989). Assessment of depression in adolescents: Objective and projective measures. Journal of Personality Assessment, 53 (3),449- 458. Lovitt, R. (1993). A strategy for integrating a normal MMPI-2 and dysfunctional Rorschach in a severely compromised patient. Journal of Personality Assessment, 60 (1), 141-147. Morey, L. C. (1991). Personality Assessment Inventory. Odessa, FL: Psychological Assessment Resources Inc.. Morey, L. C. (1996). An interpretive guide to the Personality Assessment Inventory (PAI). Odessa, FL: Psychological Assessment Resources Inc.. Nichols, D. S. (1996). Remarks on method for MMPI-Rorschach studies. Journal of Personality Assessment, 67 (3), 516-528. Runyon, R.P. & Haber, A. (1991). Fundamentals of behavioral statistics (4th ed.). New York: McGraw-Hill. Shapiro, J. P., Leifer, M., Martone, M. W., & Kassem, L. (1990). Multimethod assessment of depression in sexually abused girls. Journal of Personality Assessment, 55 (1&2), 234-248. Weiner, I. B. (1993). Clinical considerations in the conjoint use of the Rorschach and the MMPI. Journal of Personality Assessment, 60 (1), 148-152. Wilhite, S. C., & Payne, D. E. (1992). Learning and Memory. Needham Heights, MA: Allyn and Bacon. "To avoid cumbersome language, because statements in the text regarding the MMPI also apply to the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) the abbreviation “MMPI” will be used loosely to refer to both the MMPI and MMPI-2, except when citing specific research used with the MMPI-2." Author's Note : An earlier version of this article was presented at the Midwinter Meeting of the Society for Personality Assessment, Philadelphia, PA, March 2001. Correspondence concerning the article should be sent to Edward M. Petrosky 1 Station Square, Room 2, Forest Hills, NY 11375. Petrosky

Assessing Suicidal/Homicidal Impulses With the SIS Wilfred A. Cassell The four case histories in the present study serve to illustrate how the SIS can provide important information regarding violent fantasies (Cassell & Dubey, 1998, Cassell, et al, 2002). The direct and symbolic imagery projected can provide new insights enriching those obtained with standard clinical interviews. We also must learn how to more effectively incorporate its spiritual applications into clinical practice. “I have an obsession with death…death is very intriguing…its one of the only great mysteries of man that has never been solved…and it’s just my mind travels on a parallel…well it really doesn’t travel on a parallel…but it’s like my mind wants to question death…it’s like…it’s almost like it wants to experience it but yet it doesn’t” After reading about the above quotation describing a suicidal Alaskan Native youth’s “obsession” with death, are you beginning to feel a little anxious? As a thinking member of the Homo sapiens species, with a time limited body, your emotional discomfort is understandable. It means that your optic nerves are transmitting neural impulses containing language symbols to your brain’s visual areas. This is presently enabling your central nervous system to interact with your various memory pathways. Remarkably enough, in some mysterious body-mind-spirit realm, you may begin to “think’. The subject involves SIS material that even experienced mental health professionals may find anxiety provoking. After all, epidemiologic studies have always indicated that our profession has high rates of suicide. Having the ability and opportunity to think about the subject of death is both good news and bad news for you! The former is that you are in the minority of humans with sufficient neural endowment and education to cognitively process complex symbolic information. The latter is that you will be visually exposed to potentially emotionally upsetting SIS imagery projected by psychiatrically hospitalized suicidal/ homicidal Alaskan Native males. While this should stimulate the cognitive centers in your brain, it can arouse secondary empathetic pain in your heart. Moreover, as you read this article it may also stimulate you to think about your own mortality. In 1973, an anthropological professor of mine, Ernest Becker wrote a Pulitzer Prize winning book entitled The Denial of Death. His thesis was that apart from employing reassuring religious doctrine, most individuals use the mental mechanism of denial in philosophically contemplating their body’s ultimate fate By contrast, like the above cited suicidal youth, many mentally disturbed Alaskan natives are preoccupied with their death. As a clinically relevant background, perhaps it might prove of interest to briefly review the special historical, cultural and socioeconomic background features of Alaska. It was purchased from Russia in 1857 for approximately seven million dollars. At the time, most Americans considered this an outlandish price in labeling it as “Seward’s Folly”. It has turned out to be just the opposite since the state is a major supplier of natural resources. Unfortunately these developments have not always benefited Alaskan Natives. Starting with the Russian occupation foreigners began imposing their values and undermining Wilfred A. Cassell, MD, FAPA, APC, Editor IN Chief SIS Journal and Director, SIS Center, 4501E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E-Mail: siscassell@yahoo.com Key Words : Suicidal/Homicidal Impulses through SIS.

those of the Alaskan natives. For example, the newly acquired territory was divided up by the various Christian churches. The authoritarian missionaries, priests and educators then became the powerful figures in the remote communities. They taught the children that their native religion was based upon superstition and “The work of the Devil!” As the acculturation experience shattered existing related support systems and the integrity of family, a series of predictable public health problems resulted. In schools, children were informed by the outsiders that their difficulties were due to their inferior culture. Moreover, they were punished for speaking in their native language. Eventually the acculturation stress caused them to self medicate with alcohol. In some northern villages, upwards of sixty percent of infants born show evidence of fetal alcohol induced organic brain impairment. Adolescent Alaskan native males have the highest rate of suicide in the United States, a country where someone suicides every twenty minutes. Case Studies of Suicide Survivors: Case I: The first is a 31 year old Alaskan Native who was entered marital counseling with his wife. He had been intermittently suicidal since childhood. When he completed the SIS- II booklet, a flood of emotionally painful traumatic memories surfaced. In rating the SIS responses for anxiety/threat, he selected 4A as most threatening. Here he split the gestalt of the figure. He projected a childhood memory on the left portion as himself. On the right, he visualized an image of his “Monster dad”. In the detailed enquiry with great anguish he indicated that the latter reminded him of his abusive “Birth dad”. He gave the following associations: “He always beat me up…I was so small and he was so huge…I really felt inferior!” At seven years old he was placed in a foster home to protect him from his biologic parents. During this period he had Posttraumatic Stress Disorder (PTSD) dreams reliving the earlier series of traumas. To him the SIS stimulated image of the “Monster dad” brought to mind his childhood PTSD dream symbols. He selected SIS 15B as the second most upsetting one. He imagined this to represent “A window that cuts my arm!” This brought memories back of an earlier suicide attempt. Because of extensive blood loss, this had almost succeeded. A large scar on his right wrist was consistent with his story. At that time, he was under the influence of alcohol. He had gone into a jealous rage, triggered by learning that his wife had an affair with a Caucasian oilfield worker. She viewed him with a better economic future and more socially powerful, hence more sexually arousing. The third most troublesome SIS inkblot was 22B. He indicated that this reminded him of “Evil spirits!” It brought to mind “The enemy trying to put dirty thoughts into his head at night” and “Dirty pornographic movies that I replay in my mind ” He indicated that when he had trouble finding meaningful employment as a teenager, he got money as a male prostitute from pedophiliac Alaskan tourists. Next his responses to the three SIS inkblots that evoked positive feeling will be reviewed. At the top of the list was 6A which he saw as “A kind boy,” He gave associations which reflected childhood wish fulfillment fantasies and day dreams of having a close relationship with his father. However in the interview, he quickly reverted to negative memories about his father: “He never provided me a father image…sometimes I get sad and cry thinking about him but I can not raise him from the dead.” His next favorite was 10A.This brought back fond memories of “Looking through the rear window of my 1976 Chevy Monza”. Initially his emotions were positive when recalling fun times with the car. However, they soon became negative as he remembered Cassell

eventually losing the vehicle when he could no longer compete with younger native male prostitutes. His third favorite SIS stimulated projective scene was evoked with 9A. He imagined it to represent himself happily dancing with his wife. Certain other responses to the SIS-II booklet provide a projective window for revealing the past mental interplay between his intense suicidal and homicidal impulses: 3A “The inner man of me.” 8A “Me standing inside my own eyeball looking over my nose towards my wife.” (This symbolized his jealousy and paranoid like suspicions.) 13A “Someone drowning.” (This symbolized himself a few years earlier in an unsuccessful suicide attempt.) 15A “My kneecap dislocated.: (He had sustained multiple severe injuries from placing himself at high risk self injurious behaviors.) 17A “A mad wet cat coming inside out of the rain.” (Here he projected his inner murderous impulses onto the figure of a cat.) 18A “My heart broken when my wife forced me to leave.” 19A “When I am drunk looking through a wine glass and everything is fuzzy.” 8B Me looking through a telescope or a gun at the man walking towards my wife.” (Instead of cutting on himself, he almost shot the man!) 18B “An oriental dagger with blood on it.” Case II: The second case involves a seventeen year old Alaskan Native youth (JF) who reported having an obsession with death. He was admitted to a psychiatric hospital because of severe suicidal ideation. Like the older native man discussed, he too had a history of severe abuse as a child. In viewing the SIS-II Video, he rated 30A as the most upsetting inkblot. It reminded him of the past: “My mother when she is pissed at someone”. She suffered from severe mood swings and rage reactions. The next most threatening was 31A. This stimulated memories of stressful scenes of his parents fighting. The third most disturbing imagery was evoked by 13A. Here he saw “A hand and arm area with a cut on it.” He said that the scene was “Very scary!’. It triggered memories of a few years earlier when he had first tried to kill himself. His three favorite SIS inkblot were as follows: 28B “A mother hugging her child.” It reminded him of the few times that his mother was able to act in a loving fashion. 31B “A happy family.” 6A. “Me at age eight.” Here he envisioned the background figure as “A teddy bear.” However, his positive emotions quickly left. He soon was speaking about memories of when his mother was highly abusive. Certain of the other SIS inkblots evoked material relative to his suicidal history. These were as follows: 2A “Blood on the floor when I was in the third grade.” In describing this scene, he became very emotionally upset: “My father called me at night and told to immediately Suicidal/Homicidal Impuslses With SIS

run and get the police. When I was running downstairs to go outside I looked and saw my mother with a knife cutting deep wounds into her wrist. Blood was squirting out onto her arms and legs. There was a puddle on the floor. It was very, very frightening.” Following this he had recurrent anxiety laden PTSD dreams reflecting in content and affect his SIS triggered imagery. 4A “A leech crawling over a puddle of blood.” 5A “My mother when I was six shouting at me.” 7A “”A neon sign for a night club.” Here he failed to visualize a woman’s gestalt because of his PTSD induced aversion to female body imagery. 10A “An evil person!” His self concept from irrationally blaming himself as a child for his mother’s mood disorder. 16A “A crying person.” This depicted himself at age eight, sad, alone and crying by himself at night. 17A “A couple of dragons devouring a heart!” A horrible scene consistent with the symbols in his PTSD dreams. 20A “An upside down person with huge feet.” Like the older Native man, he too had frequently engaged in high risk suicidal like behavior. Shortly before hospitalization while intoxicated driving a vehicle at high speed, he had almost been killed. 25A “A valley and an ugly vagina!” 28A “A bloody arm...like mine was at fourteen!.” 1B “All consuming flames that consume every thing.” This reminded him how once had almost set his bedroom on fire. 2B “A headless person that has been ripped apart!” This reminded him of his violent video and computer games. 15B “A shattered window.” This brought to mind the shattered window of the truck that he recently had rolled. 19B “A heart eating sea urchins.” 21B “An exploding battery.” 22B “A person’s spirit leaving his body.” This brought to mind his suicidal over dose of pills that had precipitated his recent hospitalization. He exclaimed “I didn’t want to feel more pain!” Case III: The third case involved a 15 year old hospitalized youth who had been hospitalized because of serious suicidal ideation. He had a long history of psychological and physical abuse by his stepfather. He suffered from related PTSD nightmares and rage reactions. In viewing the SIS-II video he selected 25A as the most threatening inkblot. Here he conjured up an image of “A large predator fish or animal which had the capacity to hurt you!” It brought to mind traumatic memories of his abusive step father. The second most threatening SIS inkblot was 18A. This was simply too anxiety provoking for the traumatic memory to fully register in conscious awareness. The best he could do was report “It is the shape that bothers me.” He was clearly quite disturbed in seeing it again in the detailed enquiry. Cassell

The third most threatening SIS inkblot was 3B. He said that this resembled “A mask!” His associations revealed a degree of paranoid ideation: “I do not like faceless people and not being able to see their eyes!” Next attention will be directed to certain other responses which appeared to have clinical significance: 3A: “A bomb blowing up…maybe a pipe bomb.” When asked to expand on this he indicated that it reminded him of “A terrorist attack.” He appeared to be fascinated by news accounts of terrorism. He claimed that he had just read the biography of the mail bomber Ted Kozinski. He reported that frequently when he felt angry, that he fantasized about blowing up people. He quickly added “I would never do it!” His response revealed the close approximation in his mind between suicidal and homicidal impulses. Troubled and angry young people like him like could be vulnerable to terrorist propaganda. If they were living in certain war torn cultures, possibly they could easily be manipulated into becoming “suicidal bombers”. For 31A he saw “Two people yelling at each other with a red haze in the head area.” Here is significant that he focused on the “Red” This was consistent with the rage in his parent’s long term marital battles. When their anger was directed to him, he would feel alternatively fear, rage and then sadness. For 7B he saw “A gas mask,” In speaking about this he revealed a series of fantasies about being a warrior, soldier etc and participating in war. These thoughts were constantly activated when he played electronic war games which can inflame aggressive impulses (Cassell & Dubey, 1988). 19B was seen as “A broken heart trying to catch the little hearts in tentacles.” Here the symbolism reflects a mixture between his sad suicidal feelings and his violent homicidal aggressive ones. In speaking about this impulse battle he emphasized that he no longer could cry. The last time that he had this healthy release for his pent up frustrations was at age seven after his step father had abused him. Since this traumatic event, he had dissociated himself from his PTSD pain. While this defense mechanism protected him from inner cry, over time it provided the fuel for his destructive fantasy life. 27B was seen to represent “Two twins in their mother’s womb…one bad and one good.” Here the symbolism depicted the two aspects of his evolving adolescent personality. Clearly the “Bad” reflected his destructive side. Case IV: The last illustrative case involved a man who had several violent features in common with the first case. He had been episodically suicidal and had survived two serious over doses. He also had intermittent jealous rage reactions related to his wife’s infidelity and murderous impulses to kill her. Certain SIS II Booklet responses captured his suicidal/homicidal ideation: 4A “A mad cat!” This represented the projection of his own rage onto the image of a cat. Prior to hospitalization, when raging about his wife’s unfaithfulness he had killed cats. 7A “A mad woman teacher with an apple!” he claimed that his wife had anger problems and was threatening him. 27A “A woman’s breast being cut by glass!” Here again the symbolism depicts the murderous impulses that he had chosen to deny, when questioned as part of a standard mental status examination. Suicidal/Homicidal Impuslses With SIS

Unfortunately after discharge he failed to have follow-up treatment. Eventually he killed her. Three years later when incarcerated for murder, reflecting his anger and regret for having acted on his unreported homicidal impulses, he selected the scene evoked by 15B as the one that bothered him the most. It may be recalled that this particular stimulus array was designed to evoke violent fantasies. In the retest situation, he imagined this to represent “Knives with broken glass!” Discussion: In recent years American mental health practitioners have seen more violent behavior. There appears to be almost an infectious and theatrical quality at times with violence. This applies to both suicidal and homicidal violent behavior. The former has been studied under the name “suicide contagion” (Gould & Davidson 1988, Davidson& Gould 1989). This refers to the process by which exposure to the suicide or suicidal behavior of one or more person influences other to attempt or commit suicide. The effect appears to be strongest in adolescents (Phillips & Carstenson 1988, Gould et al,1990). An example of the theatrical quality of violence occurred in one northern village recently when an adolescent Alaskan Native youth set the stage for his murdering the school principal. He created an audience by boasting in advance to his peers. He informed them exactly where, when and how he was going to commit the murder. On the specified day, he had an appreciative audience of youths when he shot the victim. As is frequently the case in the United States, his photograph and life story were widely circulated in the media. Since murderers have the highest status in any criminal system, this immediately made him a hero with his peers. No doubt the publicity had some economic value to the owners of the various media enterprises, though unfortunately, it had the potential for educating others concerning the status value of “Copy cat murder”! It is amazing how some adolescents can impulsively kill, without an ounce of empathy for their victim. Several years ago, I evaluated such a cold blooded youth. The crime scene involved him being in the back of a taxi with his peers. When the driver wanted to get paid a few dollars for the ride, he put a gun to the back of his head. Reportedly the terrified victim begged for his life pleading: “Don’t shoot! I’m a married man with a wife and children!” The youth shot him! During psychiatric examination he denied remorse. Sometimes adolescents murder and then kill themselves. American Indian adolescents who live on reservations have comparable high rates of violence as their Alaskan counterparts. Recently such a Minnesota youth went on a school shooting spree. This mass murderer watched a popular movie which provided the format for the “copy cat” violence. While the hero in this film served as a role model, this also points up to the infectious quality of aggression. The teenager had communicated significant suicidal/homicidal ideation to certain interested peers through internet e-mail. Youth who are experiencing suicidal/homicidal impulses now can share and mutually fuel their violent fantasies through internet Blog groups as well. The technology has also given rise to a new form of abuse referred to as cyber-bullying. Adolescents are particularly vulnerable to this and there are now Web resources for those victimized (e.g. www.bullying.org and www.netbullies.com). American surveys reveal that a high number of young people report having violent fantasies. Yet most mass murders are not committed by adolescents in minority groups. Cassell

If there is a common denominator in epidemiologic terms, they are much more likely to be perpetrated on society by humans with male gonads. Before digressing much further, a brief review historically will be presented concerning how the SIS conceptually evolved as a projective technique for assessing violent impulses. The background is presented in my book Body Symbolism (Cassell, 1980). The original research began in 1959 with a clinical investigation of the body image problems in women with excessive facial hair (Hirsutism). It became apparent that there was a need for alternative assessment techniques, apart from standard interviews. Projective techniques appeared to have particular promise for investigating the subjective manner, whereby somatic symptoms are experienced in various medical disorders. This led me to working with the Seymour Fisher, who in association with Sidney Cleveland had originally developed two Rorschach measures of body awareness: the Barrier and Penetration Scores (Fisher and Cleveland, 1958). In examining Rorschach responses, the possibility presented itself that certain anatomical responses might reflect somatic symptom related health concerns. As an outgrowth of this, I created the Body Interior Awareness Index (Cassell, 1964) and employed this conceptualization in subsequent studies (Cassell,1965,1969,1971,1972 ). During this early period of introduction, I observed that many students at Syracuse University projected broken, mutilated and violated anatomical responses. In 1962 I began consulting in the student health infirmary at the university. Consequently I became familiar with their many stressors, including the ongoing Vietnam conflict. In addition, I had the opportunity working with George Stern a social psychologist in conducting health surveys revealing high rates of psychological morbidity. I realized that it was a mistake to solely relate their pathological anatomical responses to body image disturbances and medical symptoms. It seemed more reasonable to conceptualize certain disturbed Rorschach somatic imagery, as reflecting various forms of mental suffering, including unreported suicidal/homicidal fantasies (1977, 1979). This conceptual model played an important role in the subsequent design of SIS stimuli. For SIS –I, the embedded inkblot material in Card XVIII and XX incorporate structure capable of stimulating the projective release of violent imagery from the viewer’s brain memory systems. For SIS II the same principle provided the impetus for designing images 15B, 21B and 22B. Work to date has demonstrated how this added structure has increased the projective pulling power of the SIS. However they have added a higher degree of occupational hazard by exposing the examiner to a higher degree of secondary empathetic trauma. The four case histories in the present study serve to illustrate how the SIS can provide important information regarding violent fantasies (Cassell & Dubey, 1998, Cassell, et al, 2002). The direct and symbolic imagery projected can provide new insights enriching those obtained with standard clinical interviews. Members of this society are challenged to pursue this promising line of scientific investigation. We also must learn how to more effectively incorporate its spiritual applications into clinical practice (Cassell et al, 1997, 2001). Perhaps we may improve in therapeutically communicating with suffering individuals such as JF. “I have an obsession with death…death is very intriguing…its one of the only great mysteries of man that has never been solved…and it’s just my mind travels on a Suicidal/Homicidal Impuslses With SIS

parallel…well it really doesn’t travel on a parallel…but it’s like my mind wants to question death…it’s like…it’s almost like it wants to experience it but yet doesn’t!” Clearly his “obsession” goes far beyond reality based cognitive psychotherapy and atheistic scientific interpretation. It demands a religious response consistent with his native culture and SIS body-mind-spirit theory. This could provide the support of an empathetic bridge reaching beyond biological death into the realm of eternal spirituality. References: Becker, E. (1973) Denial of Death. New York. Free Press Cassell, W.A. (1980) Body Symbolism and the Somatic Inkblot Series. Anchorage, Alaska. Aurora Publishing. Cassell, W.A. (1964)A Projective Index of Body - interior Awareness. Psychosomatic Medicine, 26, 172-177. Cassell, W.A.(1965) Body Perception and Symptom Localization. Psychosomatic Medicine, 27, 171-176. Cassell, W.A.(1969) Responses to Inkblot Configurations Resembling the Heart, Journal of Projective Technique and Personality Assessment, 33, 123-126. Cassell, W.A. (1971) Body Consciousness in Exibitionism, British Journal of Projective Technique, 16, 21-31. Cassell, W.A. (1972) Individual Differences in Somatic Perception. Advances in Psychosomatic Medicine, 8, 86-104. Cassell, W.A. (1979) Anatomical Rorschach Response and Death Symbolism. British Journal of Projective Techniques and Personality Study, 24, 1, 7-16. Cassell, W.A. (1977) Aggressive Imagery and Clinical Symptoms in Schizophrenia. British Journal of Projective Technique, 22, 21-34 Cassell, W.A. , Dubey, B.L. and Roth, G.J. (1997) Medical Psychological and Spiritual Applications of the SIS Inkblots. SIS J. Psy & Mental health, 4, 89-112 Cassell, W.A., Collins, A., Dubey, Ilardi, F.J. & B.L. Mishra, M. (2001) Optimizing Spiritual Healing by Assessing Dreams and SIS Imageery. SIS J.of Proj. Psy. & Mental Health, 8, 75-94 Cassell, W.A. & Dubey, B,L. (1998) Mental Disorders Triggered by Exposure to Violent Imagery in the Media & electronic Games, SIS J.Proj.Psy. & Mental Health, 5:87-104 Cassell,W.A. , Schaeck, A.M. & Mohn, D. (2002) Symbolism in Violent Hallucinations. SIS J. Proj. Psyc & Mental Health, 9: 81-92 Davidson,L.E. & Gould, M.S. (1989) Contagion as a Risk Factor for Youth Suicide. I In :Alcohol, Drug Abuse, and Mental Health Administration report of the Secretary’s Taskforce on Youth Suicide. Vol. 2. Risk factors for youth suicide. Washington D.C. : US Department of Health and Human Services, Public Health Service, 88-109, DHHS publication No. (ADM) 89-1622 Fisher, S. and Cleveland, S.E. (1968) Body Image and Personality. Princeton: Van Nostrand. Gould, M.S. & Davidson, L. (1988) Suicide contagion among adolescents. In:Stiffman, A.R., Feldman, R.A., eds. Advances in adolescent mental health. Vol III. Depression and suicide. Greenwich, CT: JAI Press. Gould, M.S., Wallenstein, S., Kleinman, M.H.,O’Carroll, P.W.,Mercy, J.A. (1990) Suicide clusters: an examination of age-specific effects. Am J. Of Public Health, 80: 211-2 Phillips, D.P., Carstenson, L.L. (1988) The effect of suicide stories on various demographic groups, 1968-1985. Suicide Life Threat Behav 18:100-14 Cassell

Who’s Afraid of Rorschach Inkblots? Projective Studies in India an End Century Assessment Nilanjana Sanyal, Manisha Dasgupta, Mohor Mala Chatterjee “Odium”, characterized by a negative and violent orientation toward life, has become the highlight factor behind moulding the ‘masks’ of the psyche in the modern era (Wolfe, Wekerle and Scott, 1997). As such, the whole world is resonating with animalistic aggression of mankind. Hence, the utmost necessity to delve deeper into the raw self to identify the maladaptive defenses that increasingly pave the way for conflict-laden pathologies. Projective techniques come at the aid at this mind-boggling crossroad to loosen the self-filtered interpretative angles and wrap up the roots of the etiological probe. The Rorschach Inkblot Test (RIT) provides a sound clinical platform to assess the mazes of the psychic system. Its contribution to the assessment of propensities toward violence, impulsiveness and criminal behaviour is noteworthy (Janson & Stattin, 2003; Loving & Russell, 2000; Elfhag et al., 2003; Leavitt, 2000; Krishnamurthy & Archer, 2001). However, a relevant review of theoretical evidence in the Indian scenario pinpoint to a peculiar and alarming trend of “Rorschach avoidance”. An attempt to fathom deeper into this process intensely has been put forth in the present theoretical frame. In the present era of “value-void” and “external pomp and splendour”, the whole world seems to be “ornamented” by raw animalistic aggression of mankind, being infected by the social contaminous disease, identified as “Odium” (Wolfe, Wekerle and Scott, 1997). The human mental frame is at the verge of loosing its vitality and adaptive functioning owing to its unaccommodative nature and diminished flexibility in the parlance of interpersonal relationships. Projection becomes an important “shield” against the vulnerabilities as well as striking negative emotional qualities of the “raw self”, thereby propelling individuals to find faults everywhere around to defend the negative trends of mind. It is at this crucial juncture that the dire necessity to assess human defenses to chart out realistic means of handling and interpreting the embracing world is felt. Projective techniques come at the rescue whose clinical values as systematic methods for eliciting spontaneous responses has been demonstrated time and again (Coulacoglou, 2003). They help to fathom the deeper sources of conflicts by delving into the unconscious (Reber, 1995), thereby “straightening out” the loosened strings of behavioural adjustments in the platform of self-filtered interpretative angles. The Rorschach Inkblot Test (RIT) is one such projective technique having high temporal stability (Gronnerod, 2003) and extremely good clinical application. However, a relevant review of past literature yields a peculiar scenario of “Rorschach avoidance” for Indian psychological researches unlike Western studies. The present theoretical frame is an attempt to probe into this process intensely. I. An Overview of the Rorschach Inkblot Test (RIT): Once deemed an “X-Ray of the mind”, the Rorschach Inkblot Test remains the most famous and infamous projective psychological technique (Lilienfield, Wood and Garb, 2001). Responses to the inkblots purportedly reveal aspects of a person’s personality and mental health. In this context, Mihura, Meyer, Bel-Bahar and Gunderson (2003) found high correspondence among observer ratings of Rorschach, namely, emotional Nilanjana Sanyal**,** Professor and Head, Manisha Dasgupta and Mohor Mala Chatterjee**,* Research Scholar, Department of Psychology, University of Calcutta Key Words : Rorschach Inkblots in India.

and expressive constriction, self-centeredly exploitative and poor ego resiliency and other personality dimensions. Studies involving refinements in the Rorschach Ego Impairment Index (EII; Perry and Viglione, 1991) to incorporate the Human Representational Variable (HRV; Viglione, Perry, Jansak, Meyer & Exner, 2003), finally creating EII-2 have also been stressed. In yet another study dealing with its prediction of treatment outcome in a child psychiatric population, EII-2 scores did not predict short-term response to treatment, but instead demonstrated moderate correlations with long-term outcome and relapse (Stokes, Pogge, Powell-Lunder, Ward, Bilginer and DeLuca, 2003). As such, it involved the modification of the Rorschach Human Experience Variable (HEV; Perry & Viglione, 1991) to create the HRV to be added to the Comprehensive System (Exner, 2000). Studies suggest that the HRV has improved psychometric properties compared to the HEV and that it is simpler to understand (Viglione, Perry, Jansak, Meyer and Exner, 2003). However, several recent findings indicate that the Comprehensive System of Exner incorrectly labels many normal respondents as pathological. The initial tool came under severe attack in the 1950s and 1960s, in part because it lacked standardized procedures and a set of norms. In 1970s, Exner ostensively corrected those problems by introducing the “comprehensive system” of analysis (Exner, 1974). This set of instructions established detailed rules for delivering the inkblot exam and for interpreting the responses, and it provided norms for children and adults. Studies supportive of the comprehensive system of Rorschach (RCS) are ample in number. Wood, Krishnamurthy and Archer (2003) studied that variables on the Synthesized complexity and Form Quality factors of the RCS were generally correlated with Wechsler Full Scale IQ, Verbal IQ and Performance IQ scores. To unfurl the chapters dealing with implied values of the Rorschach Test in psychological researches, a need has been felt from the review of these studies to classify works dealing with the same psychological material, i.e., Rorschach. Hence, the following part of the present work incorporates a specific frame. II. Assessment of propensities towards violence, impulsiveness and criminal behaviour by the Rorschach: A number of studies have attempted to predict impulsive and erratic behaviours of varied dimensions from Rorschach ratings. For instance, Janson and Stattin (2003) revealed that an aggregate of Rorschach-based ratings of ego strength significantly improved the prediction of delinquency in adolescence and adulthood over and above earlier identified best predictors (mothers’ ratings of mother-child relations and externalizing problem behaviours). In yet another interesting study of Rorschach measures of aggressive drive derivatives by Mihura, Nathan-Montano & Alperin (2003), it was found that emotional impulsivity aided in predicting self-reported physical aggression potential, suicidal ideation with impulsivity and borderline features. Loving & Russell (2000) conducted an investigation on selected Rorschach variables of psychopathic juvenile offenders, and offered some support for the validity of the Rorschach as a method of detecting certain psychopathic personality features, including pathological narcissism and interpersonal detachment, in adolescent male offenders as well. Sanyal et. al.

Review of Oral Dependency by the Rorschach: A higher initial eating rate reflecting eating drive was found to be associated with Rorschach signs of stress overload and higher affective responsiveness to external stimuli (Elfhag, Barkeling, Carlsson and Rössner, 2003). The stress overload may prompt eating, and affective responsiveness may be linked to appetite through a higher sensitivity to food stimuli, thus increasing eating drive. An accelerating rate of consumption during the meal was associated with intense emotionality and oral dependency. Furthermore, despite the strong association between alcoholism and orality in psychoanalytic theory, use of the Rorschach Inkblot Test to provide empirical support for such a link has yielded decidedly mixed results. Though Masling’s Rorschach Oral Dependency (ROD) scale has shown that people with alcoholism give more oraldependent responses on the Rorschach, which is supportive of classical analytic theory, yet, recent studies provide evidence for an object relations model of dependency that suggest a balance between anaclitic dependence and complete independence (Sprohge Handler, Plant and Wicker, 2002). Rorschach – a key to predict psychological functioning in sexual victims: The surviving roots of trauma implying the prevalence of silent signs of sex abuse in patients who recover memories of childhood sex abuse as adults have also been shed light by Leavitt (2000). In addition, the Rorschach Comprehensive System was used to assess post-operative psychological functioning in transsexuals who applied for sex reassignment in adolescence (Smith, Cohen & Cohen-Kettenis, 2002). The most notable change reflected a decrease in both distorted perception and idiosyncratic perception. Another study by Michel and Mormont (2002) suggested a counter-phobic attitude underlying sex-reassignment requests among transsexuals. They were found to be typified by a stereotyped tendency to shy away from difficulties by seeking refuge into a world of fantasy filled with realistic representations, where the initiative is delegated to others. Rorschach and Psychopathology: A number of studies have focussed to find the link between varied psycho-pathological states and predictions of the RIT. Hartmann, Wang, Berg and Saether (2003) showed that the Rorschach method was able to identify cognitive and aggressive disturbances that are present in individuals who are actively depressed, and affective and coping disturbances that are present in depressed individuals. However, several other empirical studies have found the Rorschach Depression Index (DEPI) to have questionable diagnostic utility (Krishnamurthy & Archer, 2001). It is to be noted that although several investigations have examined the relationship of Rorschach Oral Dependency (ROD; Masling, Rabic and Blondheim, 1967) scores to Axis I diagnosis, there has been very little research assessing variations in ROD scores across Axis II personality disorders (PDs) (Bornstein, Hilsenroth, Padawer and Fowler,, 2000). The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index was reviewed by Jorgensen, Andersen & Dam (2000). It was indicated that the Rorschach Inkblots in India

index effectively discriminates between psychotic and non-psychotic patients and the predictive validity of both a positive and negative Schizophrenia Index was found to be high. In addition, Peled and Geva (2000) proposed a neural network model based on the perception of Rorschach inkblots. It proposes that a disturbance of context caused by altered noise-to-signal ratio at the level of single units, is responsible for schizophrenic responses to the Rorschach test. In a related study on subjects with spinal injuries, the Rorschach Inkblot Test presented emotional distress, deteriorating perceptions, extreme preoccupation with their bodies and diffuse anxiety (Benony, Daloz, Bungener, Chahraoui, Frenay and Auvin, 2002). Hence, it becomes necessary to wade through the literature, weigh the relative merits of arguments made by proponents and detractors of Rorschach assessment, and meaningfully interpret the findings of relevant studies. Stricker and Gold (1999) and Viglione (1999) praised the Rorschach, but they consistently failed to cite negative findings. Dawes (1999) obtained results that provide modest support for the Rorschach, but one of his data sets is flawed. Hiller, Rosenthal, Bornstein, Berry and Brunell- Neuleib (1999) reported the results of a meta-analysis, but among other problems, their coders were not blind to the results of all the studies. Finally, Hunsley and Bailey (1999) made a strong case for concluding that there is no scientific basis for using the Rorschach. Again, studies reviewing the Rorschach’s utility in assessing Antisocial Personality Disorder (American Psychiatric Association, 1994) and psychopathy exhibit a flawed or superficial understanding of essential theoretical and methodological issues. As such, the collected research raises serious doubts about the use of the Rorschach Inkblots in the psychotherapy office and in the courtroom, owing to the Rorschach controversy. This review openly indicates that the applicability of Rorschach Test has quite wide spectrum. Somehow, review of little earlier studies in comparison to the current one’s has offered a hint that Indian scenario of Rorschach usage is a little different to meet the query, the next section seems to have a different focus. III. Rorschach in the Indian Scenario: In the Indian context, like other countries with academic ambience and research pursuits, there are National and International Conferences on several psychological issues, Seminars and Workshops of shorter duration, to cover up specified issues to come to definite conclusions on selected aspects of behaviour. Publication of Book on Rorschach (Dubey, 1982, Manickam and Dubey, 2005), Indian Journals and Periodicals, Indian Psychological Abstracts, Abstract brochures of significant National Congress and Seminars and publication of Survey reports of Indian authors’ aid in the same procedure. These are generally treated as marks of progress in Psychology that leave behind a trail of records of by-gone day’s research in near and far past. The tracks reveal the trend of research as well as the burning psychological issues of the day. Each of these publications include a significant number of articles or abstracts. In the present mode of analysis, an attempt was taken to find out the statistical ratio-wise position of articles or abstracts using RIT amidst the total number of reported or abstracted articles. The review brought out the fact that the trail of Rorschach Inkblot usage is gradually fading from Indian psychological research parlance, specially at the end century time frame. The review also attempted to include the evidence of Ph.D. programmes of University of Calcutta, specially in the second half of the last century, to Sanyal et. al.

probe into the matter with no information of affirmative evidence to prove the point of selected assumption. The clustered reviews of different periodicals are pinpointing the fact that in terms of numerals, researches including RIT are not at all significant in India. Hence, the query, “Does Rorschach test bear a special ‘shock’ in Indian culture or else the frontliner psychologists in the end century context are somehow feeling uncomfortable to use Rorschach test being the sharp, penetrative weapon to unravel the intrapsychic conflict platform in an extremely distinct way?” The conceptual logical sequences are drawn to initiate scientific discussions on it with an etiological probe into the issue. IV. Methods employed: The major sources of scanty and erratic uses of Rorschach test at the end part of the last century in India were the products of reviews of the following major sources : Indian Psychological Abstracts Abstracts of Psychology and Educational Sciences Section of Indian Science Congress. Indian Journal of Clinical Psychology. SIS Journal of Projective Psychology and Mental Health. Indian Journal of Psychiatry. Indian Journal of Criminology. Indian Journal of Gerontology. Indian Journal of Psychological Issues. Journal of Psychological Researches. Samiksha – The Journal of Indian Psychoanalytical Society. Review of Ph.D. thesis available at the Central Library of the University of Calcutta, India. A review of the relevant literature over the last couple of decades yields an alarming declining trend in the Indian scenario that is evident from the graphical representation as shown in graph 1. These handful of evidences in support of the RIT all pave way to the likely presence of “Rorschach avoidance”, fuelling the reluctant and repulsive attitude of Indian psychologists with regard to this projective technique. Hence, the logical assumptions unfold themselves in the probing endeavour to find out the etiology of the characteristic “diminished” trend of Rorschach interest in India. Logical Assumptions: Is there any doubt being raised against projective techniques as yielding more subjective interpretations rather than objective criteria-based assessment procedures? Is such attitude pushing Rorschach usage to a corner of theoretical scientific parlance of psychological realm? Are the intrusive/penetrative cues of Rorschach responses too “threatening” in the assessment of personality profile in the context of secretive/diplomatic venues of the folds of adjustment in the current socio-political doldrums? Rorschach Inkblots in India

Graph 1 Graphical representation of the number of studies involving the Rorschach Inkblot Test (RIT) in the Indian context decade-wise Are we becoming too dependent on the easy frames of objective assessment instruments, not to work too hard on delving into the fundamental virtue of one’s personality to draw its real fragrance? Are we afraid of committing mistakes in Rorschach interpretation and offer wrong diagnoses and invite an “assessor-induced crisis” in the clinical profile of a personality? Owing to lack of psychoanalytical exposures, are Indians lagging behind psychologists of other countries in developing the clinical insights into Rorschach protocols? Since cross-validation procedures towards Rorschach interpretations are too timeconsuming, are we trying to avoid the issue of adopting inter-rater assessment comparisons? In the “feel good/feel free” era, with a jet set speed of common urban life flow, the human mental frame does not seem to be adept in delaying gratifications of any kind. Instead, prompt actions and outcomes have become their “favourites”. Are we therefore receding from in-depth attempts and understanding of intricate covert responses of mind and hence this “Rorschach avoidance”? Lack of usage of Rorschach Inkblots are seen on the part of senior psychologists of the country through review of literature. Does this factually pinpoint the logic of lesser usage of this diagnostic tool on the part of younger psychologists? The net result automatically paints a new blot of “Rorschach shock” in the scientific canvas of psychological scenarios. The frequent use of far-fetched objective neuro-psychological research and diagnostic tools together with a focus on cognitive level of dealing clinical pathologies through behavouristic modes of therapy seem to be partially obstructing the hedonistic analysis of behavioural elements through highly incisive Rorschach interpretative cues. Can this be a plausible etiology behind the intellectual pursuits of handling emotional upheavals and knotches of clinical stamps in one’s personality? Sanyal et. al.

To match with the waves of “artificial intelligence”, have we become more defensive populationwise to draw a curtain on our subjective instincts, drives, wishes, needs and desires to be roused to the “Emo-intellect” punch of motivational context to eradicate the adjustment anomalies in life? Can it be a significant cause behind turning away our face from Rorschach Inkblot usage to some other means? Hence, the burning issue of avoiding Rorschach Inkblots in research and diagnostic contexts in our country necessitates an unveiling of the underlying root causes. The glamour of such a psychological instrument does not carry a face value only, the deeper realization of psychological components in the human personality really do need the penetrative hints like Rorschach determinants and their contextual subjective individualistic analyses for anybody so to say. Isn’t it a high time to rethink about the whole issue and try to draw the relevant usage of such a valuable instrument in unfathoming the deeper, shady, hazy layers of personality even in a country like ours with prominent conservative values and strong inhibitory socialization modes? After all, a “personality” may be having a specific geographical embeddedness, but that doesn’t signify his/her psychological shrinkage, owing just to specific cultural exposure. Lets call for an inhibition-free approach toward personality unfolding, so that a knowledge repertoire of “mankind personality folds” will emerge in 21 st century psychological research canvas of the universe. Can Rorschach dependence/usage invite a silver lining in the international integrity from psychological perspectives? References: American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.), Washington, D.C. Benony, H., Daloz, L., Bungener, C., Chahraoui, K., Frenay, C. and Auvin, J. (2002). Emotional factors and subjective quality of life in subjects with spinal cord injuries. Am. J. Phys. Med. Rehabil. 81(6), 437-445. Bornstein, R.F., Hilsenroth, M.J., Padawer, J.R., Fowler, J.C. (2000). Inter-personal dependency and personality pathology : variations in Rorschach oral dependency scores across Axis II diagnoses. Journal of Personality Assessment, 75(3), 478-491. Coulacoglou, C. (2003). Fairy Tale Test, Multi-Health Systems Inc., New York. Dawes, R.M. (1999). Two methods for studying incremental validity of a Rorschach variable. Psychological Assessment, 11, 297-302. Dubey, B.L. (1982) Pragmatic view of Rorschach Inkblot Technique, National Psychological Corporation, Agra. Elfhag, K. and Barkeling, B., Carlsson, A.M. and Rössner, S. (2003). Microstructure of eating behaviour associated with Rorschach characteristics in obesity. Journal of Personality Assessment. 81(1), 40-50. Exner, J.E., Jr. (1974). The Rorschach : A comprehensive system (vol.1), New York : Wiley. Exner, J.E., Jr. (2000). A primer for Rorschach interpretation. Asheville, NC : Rorschach Workshops. Gronnerod, C. (2003). Temporal stability in the Rorschach method : A meta-analytic review. Journal of Personality Assessment, 80(3), 272-293. Hartmann, E., Wang, C.E., Berg, M. and Saether, L. (2003). Depression and vulnerability as assessed by the Rorschach method. J. of Personality Assessment, 81(3), 242-255. Hiller, J.B., Rosenthal, R., Bornstein, R.F., Berry, D.T.R. and Brunell-Neuleib, S. (1999). A comparative meta-analysis of Rorschach and MMPI validity. Psychological Assessment, 11, 278-296. Rorschach Inkblots in India

Hunsley, J. and Bailey, J.M. (1999). The clinical utility of the Rorschach : Unful-filled promises and an uncertain future. Psychological Assessment, 11, 267-277. Janson, H. and Stattin, H. (2003). Prediction of adolescent and adult delinquency from childhood Rorschach ratings, Journal of Personality Assessment, 81(1), 51-63. Jorgensen, K., Andersen, T.J. and Dam, H. (2000). The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index : A review, Assessment, 7(3), 259-280. Krishnamurthy, R. and Archer, R.P. (2001). An evaluation of the effects of Rorschach EB style on the diagnostic utility of the Depression Index. Assessment, 8(1), 105-109. Leavitt, F. (2000). Surviving roots of trauma : prevalence of silent signs of sex abuse in patients who recover memories of childhood sex abuse as adults. Journal of Personality Assessment, 74(2), 311-323. Lilienfield, S.O., Wood, J.M. and Garbn, H.N. (2001). What’s wrong with this picture? Scientific American, 284, No.5, 73-79. Loving, J.L. Jr. and Russell, W.F. (2000). Selected Rorschach variables of psychopathic juvenile offenders. Journal of Personality Assessment. 75(1): 126-141. Manickam, L.S., and Dubey, B.L. (2005) Rorschach Inkblot Test in India.: Historical Review and Perspectives for Future Action, SIS J. Proj. Psy. & Ment. Health, 2 : 61-78. Masling, J.M., Rabie, L. and Blondheim, S.H. (1967). Obesity, level of aspiration, and Rorschach and TAT measures of oral dependence. J. of Consulting Psychology, 31, 233-239. Michel, A. and Mormont, C. (2002). Was Snow White a Transsexual? Encephale, 28(1), 59-64. Mihura, J.L., Meyer, G.J. and Bel-Bahar, T. and Gunderson, J. (2003). Correspon-dence among observer ratings of Rorschach, big five model, and DSM-IV personality disorder constructs. Journal of Personality Assessment, 81(1), 149-156. Mihura, J.L., Nathan-Monteno, E. and Alperin, R.J. (2003). Rorschach measures of aggressive drive derivatives : A college student sample. J. of Perso. Assessment, 80(1), 41-49. Peled, A. and Geva, A.B. (2000). The perception of Rorschach inkblots in schizophrenia : A neural network model, International Journal of Neuroscience, 104(1-4), 49-61. Perry, W. and Viglione, D.J. (1991). The Ego Impairment Index as a predictor of outcome in melancholic depressed patients treated with tricyclic anti-depressants. Journal of Personality Assessment, 56, 487-501. Reber, A.S. (1995). The Penguin Dictionary of Psychology, Penguin Book, New York. Smith, Y.L., Cohen, L. and Cohen-Kettenis, P.T. (2002). Postoperative psychological functioning of adolescent transsexuals : A Rorschach study. Arch. Sex Behav., 31(3), 255-261. Sprohge, E., Handler, L., Plant, D.D. and Wicker, D. (2002). A Rorschach study of oral dependence in alcoholics and depressives. Journal of Personality Assessment, 79(1), 142-160. Stokes, J.M., Pogge, D.L., Powell-Lunder, J. and Ward, A.W., Bilginer, L. and DeLuca, V.A. (2003). The Rorschach ego impairment index : Prediction of treatment outcome in a child psychiatric population. Journal of Personality Assessment, 81(1), 11-19. Stricker, G. and Gold, J.R. (1999). The Rorschach : Toward a nonmothetically based, idiographically applicable configurational model. Psycho. Assessment, 11, 240-250. Viglione, D.J. (1999). A review of recent research addressing the utility of the Rorschach. Psychological Assessment, 11, 251-265. Viglione, D.J., Perry, W., Jansak, D., Meyer, G. and Exner, J.E. Jr. (2003). Modifying the Rorschach Human Experience Variable to create the Human Representational Variable. Journal of Personality Assessment, 81(1), 64-73. Wolfe, D.A., Wekerle, C. and Scott, K. (1997). Alternatives to violence – empowering youth to develop healthy relationships, Sage Publications, London. Wood, J.M., Krishnamurthy, R. and Archer, R.P. (2003). Three factors of the compre-hensive system for the Rorschach and their relationship to Wechsler IQ scores in an adolescent sample, Assessment, 10(3), 259-265. Sanyal et. al.

Diagnostic Efficiency of Schizophrenia Index and Perceptual-Thinking Index in Schizophrenia and Mania Ranjeet Kumar and C.R.J. Khess Schizophrenia Index (SCZI) was developed to identify schizophrenia by assessing perceptual and thought disturbances. Since its diagnostic efficiency was weaker than suspected, it was revised to become Perceptual-Thinking Index (PTI). To understand the relative efficiency of these indices in differentiating schizophrenia from mania, 30 actively psychotic patients from each group fulfilling the ICD-10 Diagnostic Criteria for Research were included in the study. There was a significant correlation between the indices (r= .97; P= .01; d=7.99). SCZI revealed a hit rate of 73% and 83% with cutoff 4 and 5, respectively. And, PTI showed a hit rate of 83% with cutoff 4. Overall performance of the indices and the individual criteria indicate that the PTI is marginally better than SCZI in differentiating schizophrenia from mania. Schizophrenia is a syndrome of profoundly disruptive psychopathology affecting the thought, perception, emotion, and behavior. Lack of adequate consensus on the way these disturbances manifest makes the issue of identifying schizophrenia both complex and controversial (Liberman, Barringer, Marshall et al., 1984). Psychological tools in general and the Rorschach technique in particular seem to be helpful in aiding diagnostic decisions (Dubey, Pershad & Verma, 1981; Singer & Brabender, 1993). Particularly the Rorschach comprehensive system (CS) has made considerable progress in this regard and offered a specific index called Schizophrenia Index (SCZI; Exner, 1991 & 1993). The SCZI contains 6 criteria that reflect inaccurate perception, disordered thinking, inadequate control and interpersonal ineptness. A score of 4 on SCZI indicates a probable case of schizophrenia while 5 or 6 indicates a definite case. Jorgensen, Andersen and Dam (2000) conducted a meta-analysis of SCZI and provided diagnostic efficiency statistics. In a study by Exner (1995), 82% of schizophrenic patients (N=320) were found to have a SCZI score of 4 and above. This study also indicated a high specificity for non-patient samples. Netter and Viglione (1994) conducted a study with inpatient schizophrenics and non-clinical controls, for which Jorgensen et al. (2000) reported a sensitivity of .7 and specificity of .85. Based on the findings of Ganellen’s study (1996), Jorgensen et al. (2000) reported a sensitivity of .81 with respect to the schizophrenic and depressed patients, a sensitivity of .83 with respect to schizophrenic patients normal controls, and a specificity of .90 irrespective of the control groups. However, subsequent studies raised doubts about the specificity of SCZI in general and the individual criteria in particular. Hilsenroth, Fowler and Padawer (1998) found that only criterion 4 and 5, which reflect ideational slippage and problems in judgment were more specific to psychotic disorder. They also suggested that a score of 4 or more on SCZI should not be blindly interpreted as a case of schizophrenia. It implies that SCZI has the ability to differentiate between psychotic patients and normal controls but the ability to differentiate various psychotic disorders is weaker than suspected. Ranjeet Kumar, M.M& S.P.,Asst. Prof. Cl. Psychology, Post Graduate Institute of Behavioural and Medical Sciences (Manôpachâr) Raipur (Chattis Garh) and C.R.J. Khess, M.D., Prof. Psychiatry, Central Institute of Psychiatry Kanke, Ranchi, Requests for reprints ran_psy@yahoo.co.in. Key Words : Diagnostic Efficiency of Schizo and PTI.

Therefore, SCZI was suggested to be used as a dimensional measure of psychosis (Meyer, 1993; Jorgensen et al., 2000). Low specificity of SCZI could be understood from the fact that thought and perceptual disturbances are not the hallmarks of schizophrenia alone. For the same reason, a great deal of confusion is likely to occur for schizophrenia and mania (Andreasen & Powers, 1974; Harrow & Quinlan, 1977; Johnston & Holzman, 1979; Khadivi, Wetzler & Wilson, 1997; Singer & Brabender, 1993; Solovay, Shenton & Holzman, 1987; World Health Organization, 1992). Thus bipolar mania can contribute to false positive rates of schizophrenia (Ilonen et al., 1999; Singer & Brabender, 1993). Despite this a question about the scope of SCZI in differentiating schizophrenia from mania arises considering that they differ qualitatively from each other with respect to thought disturbances and Rorschach variables (Exner, 1993; Schmidt & Fonda, 1954; Singer & Brabender, 1993). Accumulating evidence indicate that manic patients are likely to display high response productivity with emphasis on formal features of the blot, color naming responses, thought pathology indicated by high scores for WSUM6, DR2, FAB2 and reality impairment (Donolly, Murphy, & Scott, 1975; Khadivi et al., 1997; Pratap & Kapur, 1984; Wanger & Haise, 1981). But little is known about their SCZI profiles. While there was ample scope to enhance the diagnostic utility of SCZI by addressing these issues, it was revised to be a Perceptual-Thinking Index (PTI; Exner, 2000a & 2000b). Since SCZI and PTI share many criteria, the questions raised about SCZI apply to PTI too. Finding answers to these questions will go a long way in planning early interventions. A recent study in children revealed that PTI was better than SCZI in identifying thought disorders (Smith, Baity, Knowles & Hilsenroth, 2001). However these findings should be generalized cautiously to adult population as the study included psychiatric groups (e.g. conduct disorder, dysthymia, oppositional defiant disorder and attention deficit and hyperactive disorder etc.) in which thought disturbance is not an essential diagnostic criterion, and thinking and perception of children is different from adults (Arboleda & Holtzman, 1985; Viglione, 1999). The only other study on comprehensive system from this region was done with 30 depressed patients and 30 normal controls. The findings are as follows: normal controls displayed 26.9 (± 8.93) responses, 6.80 (± 2.44) W responses, 15.10 (± 26.06) D responses and 4.67 (± 3.40) Dd responses. The X+ % was .92, F+% was .90 and the X-% was .03, and the special scores were almost nil (Dhalwal, 2001). In this context, aims of the study were (i) to examine the degree of agreement between clinical psychiatric diagnosis and SCZI and PTI, (ii) to identify SCZI and PTI criteria that are specific to schizophrenia and (iii) to explore the diagnostic efficiency (specificity, sensitivity and predictive validity) of SCZI and PTI. Method: Participants: The study was conducted at the inpatient units of the Central Institute of Psychiatry, Ranchi, India from September 2000 to March 2001. Male patients’ ages 18-55 years, with an ICD-10 (World Health Organization, 1992) diagnosis of schizophrenia or mania with psychotic features were selected consecutively as per the inclusion and exclusion criteria. The study included only male patients due to low admission rates for women (Khess, Verma, Mukerjee & Das, 1997). Drug naïve or on drugs for not more than a week prior to testing, knowledge of Hindi (an Indian language) or English were the inclusion criteria. Patients with any co-morbid psychiatric illness, substance use 116 Kumar and Khess

disorders, neurological and sensory impairments and those who could not be oriented to the test were excluded. Procedure: Initially, a resident doctor in psychiatry formulated the diagnoses of patients based on a detailed psychiatric interview as per ICD-10 Criteria (World Health Organization, 1992). It was then verified through an independent interview and/or case charts by a post MD senior resident or consultant in psychiatry using ICD-10 Diagnostic Criteria for Research (World Health Organization, 1993). Initially a resident doctor identified 75 patients out of which 4 could not be oriented about the test due to their presenting status, 3 gave less than ten responses, 3 did not give consent to participate in the study, and there was diagnostic disagreement in 4 cases. It resulted in a group of 31 manic patients and 30 schizophrenic patients. But one manic patient was excluded later due to lithium toxicity. Finally, it resulted in 30 actively psychotic patients in each group. The observed interrater agreement for clinical diagnosis was 94.7%, and the agreement by chance was .51, which resulted in a k value of .89. With informed consent sociodemographic variables were recorded on a data sheet. Independent of the clinical diagnoses the first author administered and interpreted the Rorschach test as per Comprehensive System. Patients’ protocols with 14 or 12 responses with a lambda less than 1.2 were included (Exner, 1993). A score of 4 on SCZI (Exner, 1993) and 3 on PTI (Smith et al., 2001) was considered to differentiate between schizophrenic and manic patients. Twenty Rorschach protocols from each group were randomly selected and evaluated by a qualified clinical psychologist blind to the patient details. Table 1 presents the reliability statistics estimated and interpreted as per the standard guidelines (Meyer, 1999; Cicchetti, 1994; Weiner, 1991). Analyses: Data were analyzed manually and with Statistical Package for Social Sciences (SPSS for Windows Ver. 11.0). Descriptive statistics, Chi square test, independent t test and Odds ratio were applied as per their basic assumptions. Diagnostic efficiency statistics of SCZI and PTI were estimated as described by Kessel and Zimmerman (1993). Sensitivity refers to the detection rate, which measures the proportion of those with schizophrenia according to ICD-10 criteria, correctly identified by SCZI or PTI. Specificity refers to the proportion of agreement between the Indices and ICD-10 about not having schizophrenia in the present sample. Hit rate refers to the proportion of correct classification of those with and with out schizophrenia in the given sample. Positive predictive validity refers to the probability that an individual has schizophrenia given that SCZI or PTI are positive. Negative predictive validity refers to the probability that an individual does not have schizophrenia given that SCZI or PTI are negative. The effect size and base rates were calculated manually (Coolidge, 1997; Lipsey, 1990). The level of significance of .05 was adopted in this study. Results: The findings of the study are shown in tables 1-5. There were no significant differences in the mean age of schizophrenic (30.86 ± 6.80 years) and manic patients (30.96± 10.06 years). Majority of the schizophrenic patients were literates (73.3%), belonged to an urban background (60%) and had a family income of Rs. 3000-7000 per month Diagnostic Efficiency of Schizo and PTI

(73.9%). The majority of the manic patients were literates (90%), belonged to a rural background (93%), and had income less than Rs. 3000 per month (73.3%). Table1 reveals that the reliability of Rorschach segments was sound. Table 2 reveals that the schizophrenic patients had significantly high scores on both SCZI and PTI. There was a significant correlation between PTI and SCZI (r = .97; p = .01; d=7.99). Table 3 shows that the groups differed significantly on SCZI criterion 4 (c² = 34.74; df = 1; p = 0.001; d = .75) and a trend towards significant difference on criterion 5 (² = 3.35; df = 1; p = 0.067; d = .24). Table 4 reveals that the groups differed significantly on PTI criterion 3 (c² = 34.74; p = .001; d = .75) and 4 (c ² = 17.87; p = .001; d = .55). Table 5 indicates, with the existing cutoffs, PTI yielded marginally better hit rate and specificity than the SCZI. However, the hit rate of both the indices was equal when the mean scores of the schizophrenic patients were employed as the cutoffs on respective indices. Odds ratio indicate that both the indices were able to detect schizophrenia-like psychotic process. Table 1 Interscorer Agreement for 40 Rorschach Protocols. Segments k Interpretation Observed agreement Location and space .97 Excellent .98 Developmental quality .79 Excellent .87 Determinants .80 Excellent .90 Form quality .80 Excellent .87 Cognitive Special scores .87 Excellent .92 Other special scores .68 Good .93 All special scores .91 Excellent .93 M- .61 Good .95 XA .80 Excellent .93 WDA .87 Excellent .93 WSUM6 .84 Excellent .92 SCZI .89 Excellent .95 PTI .84 Excellent .92 Table 2 Group Differences on SCZI and PTI Indices Schizophrenia Mania t-test p-value Cho Interpret (n=30) (n=30) (df=58) en's ation of Mean ± SD Mean SD d effect size SCZI 5.2 ± .71 3.7 .83 7.35 .001 1.87 Large PTI 4.17 ± .75 2.62 ± .86 7.56 .001 1.98 Large Discussion: SCZI has generated considerable interest among the researchers to investigate its diagnostic utility. While some studies demonstrated that SCZI is significantly related to schizophrenia (Viglione & Hilsenroth, 2001), most of the studies concluded that it is a dimensional measure of psychosis (Hilsenroth et al, 1998; Joregensen et al., 2000). 118 Kumar and Khess

Diagnostic Efficiency of Schizo and PTI Table 3 Group differences on SCZI. SCZI Criteria Schizo- Mania² X Pearson’s Interpretation -phrenia n(%) r (Effect of Effect Size n(%) size) (X+% < 0.61) & (S-% < 0.41) or 30 (100%) 30 (100%) CNBT - (X+% < 0.50) (X-% > 0.29) 30 (100%) 30 (100%) CNBT - (FQ-> ³ Fqu) or (FQ- > FQo + FQ+) 30 (100%) 30 (100%) CNBT - (Sum level 2 special scores > 1) 22 (73%) 0 (0%) 33.90** .75 Large & (FAB2 > 0) (Raw sum of 6 special scores > 6) 26 (87%) 20 (67%) 3.35* .24 Medium or (Weighted sum of 6 special scores > 17) (M- > 1) or (X-% > 0.40) 17 (57%) 12 (40%) 3.01 .22 Small CNBT- could not be tested because the variable was constant , **p= 0.001; *p= .067 Table 4 Group differences on PTI. PTI Criteria Schizo- Mania X Pearson’s Interpretation -phrenia n(%) r (Effect of Effect Size n(%) size) XA% < .70 and WDA% < .75 26 (87%) 23 (77%) 1.00 - X-% > .29 30 (100%) 30 (100%) CNBT - Sum6Lev2> 2 and FAB2 > 0 22 (73%) 0 (0%) 33.90* .75 Large R < 17 and WSum6 > 12, or 26 (87%) 10 (33%) 17.87* .55 Medium R > 16 and Wsum6 > 17 M- > 1 or X-% > .40 17 (57%) 12 (40%) 3.01 .22 Small CNBT- could not be tested because the variable was constant. *p = .001 Table 5 Diagnostic Efficiency of SCZI and PTI P P V NPV Hit rate (%) Sensitivity Specificity Odds ratio SCZI Cutoff .66 .94 .97 .50 .79 .88 .90 .77 PTI Cutoff .69 .94 .97 .57 .81 .86 .87 .80 PPV- Positive predictive validity; NPV- Negative predictive validity, SN – Sensitivity; SP-specificity Before generalizing the findings of the previous studies it should be noted that only few included experimental groups with psychopathology as severe as schizophrenia. Since PTI is a revision of SCZI studies are required to compare them with each other to understand their relative efficiency.

With the existing cutoffs PTI showed a marginally better hit rate and specificity than SCZI. However, when the mean scores of schizophrenic patients were employed as the cutoffs both the indices showed same hit rate. These findings corroborate the earlier studies that a SCZI value of 4 indicates a significant probability that schizophrenia is present whereas a value of 5 or 6 indicates a strong likelihood of schizophrenia (Exner, 1991; Hilsenroth et al., 1998). SCZI criterion 1, 2, 3, and 6 demonstrated that perceptual problems and impairments in reality testing could be found in bipolar mania (Paratp & Kapur, 1984; World Health Organization, 1992). Hence these criteria may be useful only in detecting a psychotic process (Vincent & Harman, 1991; Hilsenroth et al., 1998). SCZI 4 and 5 indicated that the thought disturbances would be more severe in schizophrenia. Corroborating this finding with that of Singer and Brabender (1993) it can be concluded that bipolar manic patients might display high SUM 6 scores or level 2 scores in comparison to the patients with other affective disorders but not schizophrenia. Predictably all PTI criteria were not specific to schizophrenia. Criteria 3 and 4 significantly differentiated between schizophrenic and manic patients. The new segments like XA% and WDA% were not better than the existing variables in differentiating schizophrenia from mania except that the schizophrenic patients had low scores on WDA%. It reaffirms the fact that perceptual distortions are common in these disorders but significantly severe thought disturbances are characteristic of schizophrenia. These findings along with an evidence of significant correlation between PTI and SCZI suggest that both of them are equally useful in identifying schizophrenia-like psychotic process, but analyses of individual criteria suggest that PTI is marginally better than SCZI. The current findings may have relevance to other cultures, especially the US as a recent study revealed that the normative findings were not much different from that of the US (Dhalwal, 20001). While generalizing these findings some of the limitations of the Rorschach technique and the study design should be considered. Since there is a considerable evidence that the Rorschach variables offered negligible support in comparison to other readily obtained assessment information (Lilienfeld, Wood & Garb, 2000), and diagnostic precision increased when self-report measures were used additionally (Meyer, 2000), a positive score on SCZI or PTI should not be blindly interpreted as a case of schizophrenia. Small sample size, inclusion of only male patients, and lack of equal representation from the subgroups of schizophrenia are some of the limitations of the study. Future studies may include non-clinical control group and assess the clinical groups on a standardized psychopathology rating scale. As the PTI and SCZI involve tedious calculations due to which there is high chance of systematic errors, it is essential to compare them against the individual variables such as M— , contamination, confabulation, WSUM6 or related variables from Beck or Klofer system. In conclusion, PTI represent only a marginal improvement over SCZI in differentiating schizophrenia and mania. It is ideal to integrate the information obtained from the indices with the clinical history and direct interview for meaningful results. References: Andreasen, N. C., & Powers, P. S. (1974). Overinclusive thinking in mania and schizophrenia. British Journal of Psychiatry, 125, 452-456. Arboleda, C., & Holzman, P. (1985). Thought disorder in children at risk for psychosis. Archives of General Psychiatry, 42, 1004-1013. 120 Kumar and Khess

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Lipsey, M.W. (1990). Design sensitivity: statistical power for experimental research. Newbury Park: Sage Publication. Lukoff, D., Neuchterlein, K.H., & Ventura, J. (1986). Appendix A: manual for the expanded brief psychiatric rating scale (BPRS). Schizophrenia Bulletin, 12, 594-602. Meyer, G. J. (1993). The impact of response frequency on the Rorschach constellation indices and on their validity with diagnostic and MMPI-2 criteria. Journal of Personality Assessment, 60, 153-180. Meyer, G. J. (1999). Simple procedure to estimate chance agreement and kappa for the interrater reliability of response segment using the Rorschach Comprehensive System. Journal of Personality Assessment, 72, 230-255. Meyer, G. J. (2000). On the science of Rorschach research. Journal of Personality Assessment, 75, 46-81. Netter, V. E., & Viglione, D. J., Jr. (1994). An empirical study of malingering schizophrenia on the Rorschach. Journal of Personality Assessment, 62, 45-57. Paratp, S., & Kapur, M. (1984). Rorschach study on literate manics. Indian Journal of Clinical Psychology, 11, 29-34. Schmidt, H. O., & Fonda, C. P. (1954). Rorschach scores in the manic state. Journal of Psychology, 38, 427-437. \ Singer, H.K., & Brabender, V. (1993). The use of the Rorschach to differentiate unipolar and bipolar disorders. Journal of Personality Assessment, 60, 333-345. Smith, R. S., Baity, R. M., Knowles, S. E., & Hilsenroth, J. M. (2001). Assessment of disordered thinking in children and adolescents: The Rorschach Perceptual-Thinking Index. Journal of Personality Assessment, 77, 447-463. Solovay, M.R., Shenton, M.E., & Holzman, P.S. (1987). Comparative studies of thought disorder I: Mania and schizophrenia. Archives of General Psychiatry, 44, 13-20 Viglione, D. J. (1999). A review of recent research addressing the utility of the Rorschach. Psychological Assessment, 11, 251-265. Viglione, D. J., & Hilsenroth, M.J. (2001). The Rorschach: Facts, fictions and future. Psychological Assessment, 13, 452-471. Vincent, K. R., & Harman, M. J. (1991). The Exner Rorschach: An analysis of its clinical validity. Journal of Clinical Psychology, 47, 596-599. Wanger, E.E., & Haise, M. R. (1981). Rorschach and hand test data comparing bipolar patients in manic and depressive phases. Journal of Personality Assessment, 45, 240-249. Weiner, I. B. (1991). Editor’s note: interscorer agreement in Rorschach research. Journal of Personality Assessment, 56, 1. World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: Author. World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: Author. Young, R.C., Biggs, J.T., Ziergler, V.E., & Meyer, D.A. (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133: 4429-435. 122 Kumar and Khess

An Extended Scoring System of SIS-I Rakesh Kumar Many scoring systems have evolved for Rorschach Inkblot Test. There is only one scoring system for SIS-I. Current Scoring System (CSS) for SIS-I consists of only eleven indices. The present study was designed to extend CSS for SIS-I with an assumption that it will strengthen its discrimination power, promote researches and enhance the diagnostic use as well. The quantitative indices in Extended Scoring System (ESS) are grouped in four categories – (1) blot area (2) attributes (3) response category and (4) most common responses. Several specific scoring indices are added. To assess the discrimination power of Extended Scoring System (ESS) three groups of subjects were drawn - schizophrenics (n=30), manics (n=30) and normals (n=30). The patient groups were drawn from Institute of Mental Health and Hospital, Agra. SIS-I was individually administered. The analysis of results through one-way analysis of variance with Scheffe’s posthoc comparisons revealed that the added indices do discriminate the groups. The outline of ESS and results in detail are presented. Many scoring systems have evolved for Rorschach Inkblot Test. For example, Exner’s Comprehensive System, Klopfer and Kelly’s method and Beck’s system (Mishra et al. 1996). However, there is only one scoring system for SIS-I. The scoring in Current Scoring System (CSS) for SIS-I is done on following eleven indices: total responses, human responses, animal responses, anatomical responses, sex responses, movement responses, most typical responses, typical responses, atypical responses, image rejection, and pathological scales (Cassell and Dubey, 2003). Popular scoring systems of Rorschach test score responses in terms of its – (a) location, (b) determinant, (c) conventionality and (d) content. These scoring dimensions are correlated with specific aspects of personality and psychopathology. A systematic analysis of CSS indices for SIS-I across above dimensions yielded following results – (1) there is no provision of the scoring of location indices, (2) there are only two indices in determinant dimension: (i) accuracy – typical/atypical and (ii) movement; (3) there is an absence of colour and shading determinants. Because, major dimensions of scoring are either absent or have limited indices, it was intended to extend the Current Scoring System (CSS) for SIS-I with a vision that it shall strengthen discrimination power, stimulate researches and enhance its diagnostic use. Deepak and Jagdish (2002) and Ruchi, Singh and Kumar (2002) have already recommended for an extension of CSS for SIS-I. In this background, following specific objectives of the index study were formulated: Objectives: To develop An Extended Scoring System (ESS) of SIS-I. To empirically demonstrate the discrimination power of Extended Scoring System (ESS) for SIS-I. OBJECTIVE-1: Outline of the Extended Scoring System (ESS) of SIS-I: Rakesh Kumar, Ph.D., Senior Clinical Psychologist, Institute of Mental Health and Hospital AGRA, Email: pastlifeindia@yahoo.co.in Key Words: SIS-I, SIS Scoring, Extended Scoring System (ESS) of SIS-I, Inkblots.

Method: The scoring system of Beck et al (1961) was considered for addition of scoring indices in SIS-I scoring system. The outline of Extended Scoring System (ESS) is presented below: Each response is to be coded in following categories: Blot Area Attributes Response Category Most Common Responses Blot Area: Portion of the blot to which a response is given. Total Blot Area (TB) Part Blot Area (PB) Attributes: The characteristics that determine a response. Shape Quality: Shape Appropriate (SA) Shape Inappropriate (SI) Human Action (HA) Chromatic Color (CC) Black & White (BW) Response Categories: Human Content (HC) Animal Content (AC) Internal Organ (IO) Most Common Response (MC) Others: Aggregate Responses (AR) Un-intercepted repetition Color label Image rejection Objective-2: Discrimination Power of Extended Scoring System (ESS) of SIS-I: Method: A sample of 90 participants was drawn in three groups: Schizophrenia (n=30), Mania (n=30) and Normals (n=30). The patient groups were drawn from Institute of Mental Health and Hospital, Agra. The normals were sampled from general population. SIS-I was individually administered on each participant. The data on all the indices except 124 Kumar

aggregate responses (AR) were transformed into percent scores taking AR as denominator. The data was processed in SPSS 8.0.0 to compute one way analysis of variance and Scheffe’s post hoc comparisons. Results: The characteristics of the sample are presented in following table: Table 1 Sample Characteristics Characteristics Normal Schizophrenics Manics (n=30) (n=30) (n=30) Age (in years) Mean 33.54 ± 8.54 31.78 ± S.D. 8.71 33.68 ± 7.26 Education Literate Illiterate Occupation Business Service Others Family Type Joint Nuclear Marital Status Married Unmarried Domicile Rural Urban Mean and S.D of ESS indices are given in table-2: Table 2 Mean and S.D. of Percent ESS Indices Groups A R T B PB SA S I H A C C B W H C A C I O U R C L I R Normal Mean 26.53 14.87 82.77 71.76 22.30 3.02 1.05 .00 8.21 24.94 23.90 .46 .22 10.72 (n=30) S.D. 6.12 8.07 7.88 11.92 10.74 4.10 2.13 .00 7.15 6.76 13.76 1.46 .86 9.68 Manics Mean 26.00 23.9 74.09 44.09 44.13 4.46 4.84 .48 10.98 21.66 20.47 1.52 .30 8.33 (n=30) S.D. 5.55 14.43 13.89 13.80 11.85 5.10 5.92 2.04 9.14 10.86 19.63 2.69 1.65 9.69 Schizo. p. Mean 22.13 20.31 77.12 42.11 45.39 2.09 7.06 2.73 13.09 29.92 17.48 4.34 2.52 10.30 (n=30) S.D. 4.44 13.86 13.72 14.40 12.65 4.75 8.99 7.97 13.97 16.45 18.66 7.33 4.83 15.86 The results of Scheffe’s post hoc comparisons are presented in following table: Table-2 revealed that in comparison to normals, the schizophrenics have lower aggregate responses (AR), lower shape appropriate (SA), higher shape inappropriate (SI), higher chromatic colour (CC), higher un-intercepted repetition (UR) and higher colour label (CL). The comparisons of normals vs. manics revealed significant differences in total blot area (TB), part blot area (PB), shape appropriate (SA) and shape inappropriate (SI). Extended Scoring System of SIS-I

Table 3 Scheffe’s Post hoc Comparisons of ESS Indices in Schizophrenia, Mania and Control ESS Indices (I) NM (J) MS Mean (I-J) Standard Significance Difference Error Level Aggregate Responses Normal Manics .53 1.40 n.s Schizophrenics 4.40 1.40 .01 Manics Schizophrenics 3.86 1.40 .05 Total Blot Area* Normal Manics -9.02 3.21 .05 Schizophrenics -5.44 3.21 n.s Manics Schizophrenics 3.58 3.21 n.s Part Blot Area* Normal Manics 8.67 3.13 .05 Schizophrenics 5.64 3.13 n.s Manics Schizophrenics -3.03 3.13 n.s Shape Appropriate Normal Manics 27.67 3.46 .01 Schizophrenics 29.65 3.46 .01 Manics Schizophrenics 1.98 3.46 n.s Shape Inappropriate Normal Manics -21.82 3.04 .01 Schizophrenics -23.09 3.04 .01 Manics Schizophrenics -1.26 3.04 n.s Human Action Normal Manics -1.44 1.20 n.s Schizophrenics .92 1.20 n.s Manics Schizophrenics 2.36 1.20 n.s Chromatic Color* Normal Manics -3.78 1.63 n.s Schizophrenics -6.01 1.63 .01 Manics Schizophrenics -2.22 1.63 n.s Black & White* Normal Manics -.48 1.22 n.s Schizophrenics -2.73 1.22 n.s Manics Schizophrenics -2.24 1.22 n.s Human Content Normal Manics -2.76 2.70 n.s Schizophrenics -4.88 2.70 n.s Manics Schizophrenics -2.11 2.70 n.s Animal Content Normal Manics 3.28 3.10 n.s Schizophrenics -4.97 3.10 n.s Manics Schizophrenics -8.25 3.10 .05 Internal Organs Normal Manics 3.42 4.53 n.s Schizophrenics 6.42 4.53 n.s Manics Schizophrenics 2.99 4.53 n.s Un-intercepted Repetition* Normal Manics -1.06 1.18 n.s Schizophrenics -3.88 1.18 .01 Manics Schizophrenics -2.82 1.18 n.s Color Label* Normal Manics -7.6667E-02 .77 n.s Schizophrenics -2.29 .77 .01 Manics Schizophrenics -2.22 .77 .01 Image Rejection Normal Manics 2.39 3.12 n.s Schizophrenics .42 3.12 n.s Manics Schizophrenics -1.96 3.12 n.s * Added Indices 126 Kumar

Table-3 indicates that ESS indices significantly discriminated the groups. In Normal vs. Schizophrenics comparisons, following ESS indices are statistically significant – aggregate responses (AR), shape appropriate (SA), shape inappropriate (SI), chromatic colour (CC), un-intercepted repetition (UR) and colour label (CL) (table-3). Inter-group comparison of schizophrenics and manics resulted in significant differences in aggregate responses (AR), animal content (AC) and colour label (CL) (table-3). It is noticed that manics have higher aggregate responses (AR), lower animal content (AC) and lower colour label (CL) (table-2). Discussion: The expansion of current scoring system (CSS) for SIS-I resulted in additional scoring indices. Following indices are added in the extended scoring system – total blot area (TB), part blot area (PB), chromatic color (CC), black & white (BW), un-intercepted repetition (UR), and color label (CL). The extended scoring system (ESS) incorporated scoring indices in all the major dimensions – blot area, determinants, content, and conventionality. Hence, ESS supplemented the current scoring system (CSS). Moreover, ESS created an avenue for additions of even more quantitative and qualitative indices. Researches shall be needed to explore more indices and establish personality correlates of each indice. It was hypothesized that extended scoring system (ESS) shall allow comparisons on more dimensions and indices which shall strengthen discrimination power of SIS-I. To examine this hypothesis, the ESS indices were compared across three groups – schizophrenia, mania, and normals. The results unequivocally demonstrated that ESS indices are powerful enough in differentiating clinical groups. The indices of ESS were compared in the present study. Following indices yielded significant differences across groups – aggregate responses (AR), shape appropriate (SA), shape inappropriate (SI), chromatic color (CC), total blot area (TB), part blot area (PB), and animal content (AC). Of significant indices, four are present in current scoring system (CSS); and remaining ones are additions of extended scoring system (ESS). Higher number of significant indices of ESS point out to the enhanced discrimination power of ESS. CSS has already been used for comparisons of major psychiatric disorders. For example, schizophrenia vs. normals (Kumar et al, 2001); mania, depression, and normals (Kumar & Jagdish, 2002), normal vs. mania (Kumar et al 2003), and schizophrenia vs. mania (Kumar et al 2004). Results of the present study can not be compared with the results of above studies because of the differences in the scoring system. Conclusion: Extended Scoring System (ESS) for SIS-I produced additional scoring indices in all the major dimensions – blot area, attributes, response category and conventionality. Incorporated indices of ESS strengthened the discrimination power of SIS-I. Researches on other clinical conditions shall further establish discrimination power of ESS indices and personality correlates of each indice. Extended Scoring System of SIS-I

References: Beck, S.J., Beck, A.G., Levitt, E.E., and Molish, H.B. (1961). Rorschach’s Test: Basic Processes. New York: Gurne & Strattons. Casell,W.A. and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot Series. Alaska: Somatic Inkblot Centre. Jain,R., Singh,B. and Kumar,R. (2002). Diagnostic Indicators on SIS-I and Rorschach among the Children with Attention Deficit Hyperactivity Disorder. Doctoral Dissertation Submitted to CCS University, Meerut. Kumar,D. and Jagdish (2002). Diagnostic Indicators on SIS-I and Rorschach among Manic and Depressive Patients. Doctoral Dissertation Submitted to Dr. B.R. Ambedkar University, Agra. Kumar,S., Mohanty,S. and Kumar,R. (2003) SIS-I Profile and its Correlation with Rorschach in Manic Patients. SIS Journal of Projective Psychology & Mental Health,10,201-204.7 Kumar,S., Singh, R. and Mohanty, S. (2001). A study of Somatic Inkblot Series-I in Hospitalized Male Chronic Schizophrenics. SIS Journal of Projective Psychology & Mental Health, 8, 31-34 Kumar,S., Singh, R. and Mohanty, S. (2004). Comparative Study of SIS-I Indices between Schizophrenic and Manic Patients.. SIS Journal of Projective Psychology & Mental Health, 11, 91-94. Mishra, R.K., Kharkwal, M.K., Kirley, M.A., and Thapa,K. (1996) Rorschach Test: Theory and Practice. New Delhi: Sage Publication. 128 Kumar

A Comparative Cognitive Profile of Epileptic and Non-Epileptic Normal Preadolescents Nilanjana Sanyal and Nandhini Rajagopalan Prevalence of Epilepsy in current population is drawing special attention. The present study is a venture to unfold the Cognitive profile of such a sample. A sample of 60 subjects, 30 epileptic preadolescents, aged 10-14 years, and a matched group of 30 non-epileptic normals (15 boys and 15 girls in each group of epileptics and non-epileptic normals) were taken. They were matched in terms of age (10-14 years), sex (15 boys and 15 girls), educational level (Class IV – VII in both sexes), religion (Hinduism) and socio-economic status (lower socio-economic status) and were screened on Bender Gestalt Visuo-Motor Test (BGVM) and tested to get a comparative cognitive profile of epileptic and non-epileptic normal preadolescents. The tests administered were Wechsler Intelligence Scale for Children (WISC), Conners Abbreviated Rating Scale, PGI Memory Scale (Remote, Recent and Immediate Memory), Vineland Social Maturity Scale and Benton Visual Retention Test. The results revealed that there were significant differences between epileptics and non-epileptic normals in the cognitive domains of intelligence, attention, remote memory, recent memory and also in social maturity and visual retention. No significant difference was noted between epileptics and non-epileptic normals in case of immediate memory. Significant effect of gender variation was also not present and there was no interaction effect of epilepsy and sex in any of the variables. Interractional fire, clashes, conflicts and destructions are composing the key tone of our current living. Flashes of impulsive behaviours are evident in each and every sphere of life. Scientific programmes along with socio-political interventions are trying to understand the origin and nature of such impulses and are attempting to probe into the dynamics of impulsive behaviour to come to a decision of handling them in an effective way. In Mental Health perspective a root of such impulsive behaviours even in a child is conceived to be the area of “Epileptic Disorder” (Brown et al.1993). Epilepsy is a symptom caused by neurological deficit. Epilepsy is derived from the Greek word meaning “to seize upon” and is synonymous with seizure disorder. It is a common disorder resulting from seizures that temporarily impair brain function. A seizure is a transient paroxysmal pathophysiological disturbance of cerebral function that is caused by a spontaneous, excessive discharge of neurons. Patients are said to have epilepsy if they have a chronic condition characterized by recurrent seizures (Gastaut 1973) and a seizure is an occasional, an excessive and disorderly discharge of nerve tissues i.e., an episode of altered behaviour/consciousness, which results from an abnormal electrical paroxysmal discharge in cerebral neurons (Taylor 1958). Epilepsy is a common neurological disorder which has associated features of cognitive disturbances at times along with behaviour pathologies of various kinds. To control impulsivity resulting from epileptic conditions is one of the significant medically attempted area of the present day researches (Cowan et al., 1989, Goldstein and Polkey 1993, Hauser and Annegers 1993). The review of probable causes and effects of such disorder has generated sufficient concern in psychological perspective (Gibbs et al., 1948, Gastaut et al., 1955, Gloor et al., 1982, Leiderman et al., 1990). The present attempt is to probe into the cognitive profile of epileptic preadolescents to see their Nilanjana Sanyal Ph.D., Professor & Head, and Nandhini Rajagopalan Research Scholar, Department of Psychology, Calcutta University. Key Words : Cognitive Profile of Epileptics.

differences if there is any from epilepsy free preadolescents with same demographic conditions. The expectation in terms of the finding will be in the line of understanding the sources of distortion in cognition and their effect on general behaviour pattern to help society to develop certain strategies of erasing the ill effects of the issue. At this juncture the need is felt to review the available literature in the line. Impairment in the cognitive abilities and a decline of intellectual functions has been documented for many years as a complication of epilepsy. Findings are mainly in favor of impairment in sensory process, attention and concentration, learning and memory language skills, perceptual abilities, conceptual process, reasoning and motor skills (Dewhurst, 1980, Mayeux et al.,1980, Sass et al., 1992b, Bjornaes, Stabell, Henriksen, Yngre, 2001, Nolan, Redoblado, Lah, Sabaz, Lawson, Cunningham, Bleasel, Bye, 2002). Memory function is an area that has been studied extensively for more than a 100 years. Impaired functions are long-term memory (Mayeux et al., 1980), immediate recall and learning (Loiseau et al., 1983, 1988). Delayed recall (Aikia et al., 1992), and verbal and visual memory (Helmstaedter et al., 1991, Sass et al., 1992a). Ratti et al., (1992) reported that remote memory was impaired in the epilepsy group, with no difference between patients with right or left temporal lobe seizures. Epileptic subjects showed poor sustained attention (Mirsky et al., 1960, Lansdell and Mirsky, 1964, Aldenkamp et al., 1990, Helmstaedter et al., 1991), impaired selective attention (Stores, 1973: Loiseau et al., 1984) and deficit in focused attention (Aldenkamp et al., 1990). Epileptic patients had poor arithmetic skill (Bagley, 1971; Green and Hartledge, 1971; Ross et al., 1978; Seidenberg et al., 1986). Significantly more children with epilepsy display behaviour disorders than do their own siblings (Epir et al., 1984), same age and ability peers (Clement and Wallace 1990), and children with other chronic diseases such as diabetes (Hoare and Mann 1994). Alwash et al. (2002) found significant adjustment difficulties in epileptics. Visual spatial skills are reported to be poor in epileptic patients (Schwartz and Dennerll, 1970; Morgan and Groh, 1980; Helmstaedter et al., 1991). Farwell et al (1985) did detailed neuropsychological testing of 118 epileptic children, ages 6 to 15 and a control group of 100 children without seizures. The WISC full-scale IQ of seizure patients was significantly lower than that of controls. Roy (1994) in a sample of 20 epileptics found impairment in motor functions, visualmotor coordination, rhythm, expressive speech, memory and intellectual functioning. Jahan, Nizamie & Nizamie (2000) studied Neuro-psychological deficits in epileptic patients (120 epileptics and 30 normal controls were compared on LNNB, Luria- Nebraska Neuropsychological Battery). The main deficits were impairment in smooth co-ordinated movement, visuo-spatial abilities, memory with interference and logical memory etc. Taking all these factors together it has been well realized that the cognitive mappings of epileptics, children as well as adults, seem to differ in multidimensional psychological context. A scientific need is felt to draw this profile, develop strategies to mend them wherever it is possible so that these people can also have health in their system to their best possible extent and be contributory to societal development. In general, any 130 Sanyal and Rajagopalan

mental health programme, to be successful, aims at early detection of symptoms and prevention, rather than cure. The objectives of the present study is to trace if there are any impairments or deterioration in the intellectual functioning, attentional process, memory process, social maturity and visuo-retention capacity of epileptic children as compared to non-epileptic normal counterparts. Method : Participants: Total Sample (N=60) was divided into two – Sample 1 and Sample 2. Sample1 consisted of 30 Epileptics and Sample 2 of 30 Non-epileptic Normal controls, each comprising of 15 boys and 15 girls. Both the samples were matched in terms of age (10-14 years), sex, educational level, religion (Hinduism), and socio-economic status (lower). Apparatus: In the present study the following tools were used for collecting data :- 1 ) Information Blank: It was prepared to elicit the subject’s Name, age, sex, religion, education, address, school, phone number of the patient (if any), family history, medical history, personal history, personality and general observations. 2 ) Bender Gestalt Visuo-Motor Test: The Bender Gestalt Visuo-Motor Test (Lauretta Bender, 1938) was administered on the epileptic patients as a screening test and the same was also administered on the nonepileptic normal subjects as a screening test in order to rule out the possibility of any neurological disturbance in them. 3 ) Wechsler Intelligence Scale for Children (WISC): WISC was administered to see the effect of epilepsy on the intellectual functioning of epileptics as compared to that of the non-epileptic normals. 4 ) Conners Abbreviated Ratin Scale: The scale was developed by Conners (1997). The results indicate the degree of attention deficit. 5 ) PGI Memory Scale: The Bengali version of this scale (The Scale was originally developed by Pershad and Wig (1988) with its Bengali version was administered.The Scale was administered to find out the degree of impairment in the memory process of the epileptics as compared to that of the non-epileptic normals. 6 ) Vineland Social Maturity Scale: Developed by E.A. Doll, the Vineland Social Maturity Scale (VSMS) since 1935 has been used in this work is the Indian Adaptation by Dr.A.J.Malin. 7 ) Benton Visual Retention Test: Benton’s Visual Retention Test (Benton, 1963) is a revised test and is a clinical and research instrument designed to assess visual perception, visual memory and visuoconstructive abilities. Cognitive Profile of Epileptics

Procedure: The Head of the Neurology Department of S.S.K.M. Hospital, O.P.D. Section, Kolkata was personally approached and arrangements were made to collect data from the department. Epileptic patients were selected on the basis of relevant doctor’s recommendations about them. Further verification of their ailments was done by administration of the Bender-Gestalt Visuo-Motor Test on them. The same screening test was administered on the non-epileptic normal subjects in order to rule out the possibility of any neurological disturbance in them. Data were collected always individually. Both sets of subjects were matched in their demographic profile. In each case rapport was established and they were told that information would be kept absolutely confidential. The selected Test Battery was administered on them carefully. As the tests are time consuming few of them were administered on 2 days to patients who could not give much time on a single day. The collected data were scored and appropriate statistical analysis were done on them. Results: Table 1 Combined Means (M) and Standard Deviations (S.D) Along with their T-Scores of the Following Selected Variables Between the Epileptic and Non-Epilept ic Normal Samples. Epilepsy Non-Epileptic Normal Boys Girls Boys Girls Test M S.D M S.D M S.D M S.D t-score WISC 87.06 8.18 85.4 7.14 104.27 11.71 8.82 6.03(S) Conners ARC 18.47 6.65 17.27 5.49 6.4 4.66 6.53 2.89 8.77(S) PGI MC 4.73 1.16 3.93 0.96 5.73 0.46 5.87 0.35 6.68(S) (Remote Memory) PGI MC 4.6 0.63 4.07 0.96 4.87 0.35 4.73 0.46 2.77(S) (Remote Memory) PGI MC 14.07 8.84 17.73 11.31 13.87 9.8 23.93 11.92 1.05(NS) (Immediate Memory) VSMS 66.82 13.84 75.06 18.13 105.58 11.77 100.64 7.4 9.46(S) BVRT 10.47 4.93 7.4 3.85 21.33 6.07 23.13 5.88 9.64(S) Abbreviated Rating Scale (ARC) PGI Memory Scale (PGI MS) Benton Visual Retention Scale ( BVRT) S = Significant and NS = Not Significant at .05 and .01 level 132 Sanyal and Rajagopalan

Table 2 Comparison of Means (M) and Standard Deviations (S.D) Between Epileptic and Non-Epileptic Normal Samples of the Following Selected Variables. WISC Conners PGI M S VSMS BVRT A R C Remote Recent Immediate Memory Memory Memory Sample 1: Epileptics M 86.23 17.87 4.33 4.33 15.9 70.94 8.93 S.D 7.59 6.03 1.12 0.84 10.15 16.39 4.62 Sample 2: Non-epileptic Normal M 100.63 6.47 5.8 4.8 18.9 103.11 22.23 S.D 10.84 3.81 0.41 0.41 11.88 9.98 5.94 Abbreviated Rating Scale (ARC) PGI Memory Scale (PGI MS) Benton Visual Retention Scale ( BVRT) Table 3 Means (M) and Standard Deviations (S.D) for Gender Comparison of Epileptic and Non-Epileptic Normal Samples of the Following Selected Variables WISC Conners PGI M S VSMS BVRT A R C Remote Recent Immediate Memory Memory Memory Boys M 95.67 12.43 5.23 4.73 13.97 86.19 15.9 S.D 13.23 8.34 1.01 0.52 9.17 23.41 7.75 Girls M 91.2 11.9 4.9 4.4 20.83 87.85 15.27 S.D 9.85 6.96 1.21 0.81 11.84 18.83 9.37 Abbreviated Rating Scale (ARC) PGI Memory Scale (PGI MS) Benton Visual Retention Scale ( BVRT) Table 4 The F-Ratio (two-way Analysis of Variances, Anova) for Epileptic and Non-Epileptic Normal Samples of the Following Selected Variables WISC Conners PGI M S VSMS BVRT A R C Remote Recent Immediate Memory Memory Memory Epilepsy 20.02(S) 39.95(S) 26.44(S) 4.23(S) 0.62(NS) 71.39(S) 53.48(S) Sex 1.93(NS) 0.09(NS) 1.36(NS) 2.2(NS) 3.25(NS) 0.18(NS) 0.12(NS) Epilepsy x Sex 0.76(NS) 0.14(NS) 2.68(NS) 0.8(NS) 0.71(NS) 2.97(NS) 1.79(NS) S = Significant and NS = Not Significant at .05 and .01 level Cognitive Profile of Epileptics Samples Variables Samples Variables Samples Variables

Discussion: The overall impression that has been found from the obtained results signify that distinctive differences are existing in the cognitive profiles of epileptic preadolescents from that of their non-epileptic so called normal counterparts. Table 1 is clearly hinting at the major differences between these samples. The t scores in Table 1 are indicative of the fact that there are significant differences between epileptics and non-epileptic normal counterparts. It is seen that the epileptics have poor cognitive functioning as compared to that of their non-epileptic normal counterparts with an exception in the area of Immediate Memory (PGI Memory Scale). The possible logic behind such differences may be due to the fact that since all the subjects of the study belonged to lower socio-economic group, it is expected that adequate intellectual stimulation was not available to them. Contextually relevant factor may be lack of nutrition in their life which might have its detrimental effect on the lowered rate of intelligence in them. Poor span of attention might be due to neurological deficit leading to attentional deficit. Capacity to remember and recall remote and recent events might also be affected due to the neurological imbalances. This might also be due to easy distractibility in their system and poor attention span whereas the nonepileptic normals have more concentration. The results in case of PGI Memory Scale (Immediate Memory) may be due to the fact that all the preadolescents of the present study are either of average or close to average intelligence who tend to have more or less a stable memory system. The similarities in the demographic conditions may be accounted for in having similar memory pattern not being affected by gender variation. Poor social maturity clearly refers to behaviour and adjustment disorders which might also be accounted for by the frustrated attitude of surrounding people in general and lack of co-operation from society, friends and peers. Poor visual perception and visual retention capacity clearly indicates the presence of neurological deficits in case of epileptics as compared to their non-epileptic normal counterparts. In the second fold of detailed analysis of the findings in terms of selected specific variables being traced by separate psychological tests, attempts were being taken to offer possible psychological explanations of the obtained differences in the following fashion: Wechsler Intelligence Scale for Children (WISC): In case of WISC, from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 87.06 and 8.18 respectively. The same for the nonepileptic normal boys are 104.27 and 11.71. Similarly, the mean and SD scores for epileptic girls are 85.4 and 7.14 and for non-epileptic normal girls are 97 and 8..82 respectively. The t scores in Table 1 are further indicative that there is significant difference between epileptics and non-epileptic normals in this respect. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 86.23 and 7.59 and for non-epileptic normal boys and girls are 100.63 and 10.84 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 95.67 and SD is 13.23. Similarly the mean and SD for epileptic and nonepileptic normal girls are 91.2 and 9.85 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. But it is seen that there is no significant difference between sexes and also between the interaction effect of sex and epilepsy. Thus, from Table 2 it can be clearly said that nonepileptic normals have significantly more WISC scores as compared to epileptics. The 134 Sanyal and Rajagopalan

above findings are in line with a study conducted by Farwell et al (1985) who did detailed neuropsychological testing of 118 epileptic children, ages 6 to 15 and a control group of 100 children without seizures. The WISC full-scale IQ of seizure patients was significantly lower than that of controls. Children with minor motor or atypical absence seizures had the lowest average full-scale IQ. Conners Abbreviated Rating Scale: In case of Conners Abbreviated Rating Scale, from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 18.47 and 6.65 respectively. The same for the non-epileptic normal boys are 6.4 and 4.66. Similarly, the mean and SD scores for epileptic girls are 17.27 and 5.49 and for non-epileptic normal girls are 6.53 and 2.89 respectively. The t scores in Table 1 are indicative that there is significant difference between epileptics and non-epileptic normals in this respect. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 17.87 and 6.03 and for non-epileptic normal boys and girls are 6.47 and 3.81 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 12.43 and SD is 8.34. Similarly the mean and SD for epileptic and non-epileptic normal girls are 11.9 and 6.96 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. In this regard also it is seen that there is no significant difference between sexes and also between the interaction effect of sex and epilepsy. The following studies support the above finding, that epileptic subjects showed poor sustained attention (Mirsky et al., 1960, Lansdell and Mirsky, 1964, Aldenkamp et al., 1990, Helmstaedter et al., 1991). PGI Memory Scale (Remote, Recent and Immediate Memory: In the context of PGI Memory Scale (Remote Memory), from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 4.73 and 1.16 respectively. The same for the non-epileptic normal boys are 5.73 and 0.46. Similarly, the mean and SD scores for epileptic girls are 3.93 and 0.96 and for non-epileptic normal girls are 5.87 and 0.35 respectively. Further the t scores in Table 1 are indicative that there is significant difference between epileptics and non-epileptic normals in this respect. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 4.33 and 1.12 and for non-epileptic normal boys and girls are 5.8 and 0.41 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 5.23 and SD is 1.01. Similarly the mean and SD for epileptic and nonepileptic normal girls are 4.9 and 1.21 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. In this context too it is noted that there is no significant difference between sexes and also between the interaction effect of sex and epilepsy. Thus, from Table 2 it can be clearly said that non-epileptic normals have significantly more remote memory scores as compared to epileptics. In the domain of PGI Memory Scale (Recent Memory), from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 4.6 and 0.63 respectively. The same for the non-epileptic normal boys are 4.87 and 0.35. Similarly, the mean and SD scores for epileptic girls are 4.07 and 0.96 and for non-epileptic normal girls are 4.73 and 0.46 respectively and the t scores in Table 1 are indicative that there is significant difference between epileptics and non-epileptic normals in this respect. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 4.33 and 0.84 and for non-epileptic normal boys and girls are 4.8 and 0.41 Cognitive Profile of Epileptics

respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 4.73 and SD is 0.52. Similarly the mean and SD for epileptic and nonepileptic normal girls are 4.4 and 0.81 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. It is also seen that there is no significant difference between sexes and also between the interaction effect of sex and epilepsy. Thus, from Table 2 it can be clearly said that nonepileptic normals have significantly more recent memory scores as compared to epileptics. Memory function is an area that has been studied extensively for more than a 100 years. Impaired functions are noted for long-term memory (Mayeux et al., 1980), immediate recall and learning (Loiseau et al., 1983, 1988), delayed recall (Aikia et al., 1992), and verbal and visual memory (Helmstaedter et al., 1991, Sass et al., 1992a) in case of epileptics. Ratti et al., (1992) tested fifteen patients with temporal lobe epilepsy on a remote memory questionnaire, and compared their response with fifteen controls matched for age and educational level. The authors report that remote memory was impaired in the epilepsy group, with no difference between patients with right or left temporal lobe seizures. In case of PGI Memory Scale (Immediate Memory), in the present work, from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 14.07 and 8.84 respectively. The same for the non-epileptic normal boys are 13.87 and 9.8. Similarly, the mean and SD scores for epileptic girls are 17.73 and 11.31 and for non-epileptic normal girls are 23.93 and 11.92 respectively. The t scores in Table 1 are indicative that there is no significant difference between epileptics and non-epileptic normals. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 15.9 and 10.15 and for non-epileptic normal boys and girls are 18.9 and 11.88 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 13.97 and SD is 9.17. Similarly the mean and SD for epileptic and non-epileptic normal girls are 20.83 and 11.84 respectively. The F-ratio in Table 5 indicates that there is no significant difference between epileptics and non-epileptic normals. And there is also no significant difference between sexes and also between the interaction effect of sex and epilepsy. Vineland Social Maturity Scale (VSMS): In the realm of Vineland Social Maturity Scale (VSMS) from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 66.82 and 13.84 respectively. The same for the non-epileptic normal boys are 105.58 and 11.77. Similarly, the mean and SD scores for epileptic girls are 75.06 and 18.13 and for nonepileptic normal girls are 100.64 and 7.4 respectively. Here too the t scores in Table 1 are indicative that there is significant difference between epileptics and non-epileptic normals. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 70.94 and 16.39 and for non-epileptic normal boys and girls are 103.11 and 9.98 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 86.19 and SD is 23.41. Similarly the mean and SD for epileptic and non-epileptic normal girls are 87.85 and 18.83 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. No sex difference had been located in this respect too. Significant difference in the interaction effect between sex and epilepsy is also not noted. Thus, from Table 2 it can be clearly said that non-epileptic normals have significantly more VSMS scores 136 Sanyal and Rajagopalan

as compared to epileptics. A study in this direction reveal that significantly more children with epilepsy display behaviour disorders than do their own siblings (Epir et al., 1984), same age and ability peers (Clement and Wallace 1990), and children with other chronic diseases such as diabetes (Hoare and Mann 1994). Alwash et al. (2002) found significant adjustment difficulties in epileptics. Results showed that age and sex matched control subjects had attained a higher educational level, had better living circumstances and were less dependent on their parents for their daily activities than the epileptic subjects. The findings also suggest that parental behaviour toward epileptic children may delay psychosocial maturation. Benton Visual Retention Test: With regard to Benton Visual Retention Test, from Table 1, it is seen that the mean scores and standard deviation (SD) scores for epileptic boys are 10.47 and 4.93 respectively. The same for the non-epileptic normal boys are 21.33 and 6.07. Similarly, the mean and SD scores for epileptic girls are 7.4 and 3.85 and for non-epileptic normal girls are 23.13 and 5.88 respectively. The t scores in Table 1 are indicative that there is significant difference between epileptics and non-epileptic normals in this respect too. Table 2 indicates that the mean and SD scores for the epileptic boys and girls are 8.93 and 4.62 and for non-epileptic normal boys and girls are 22.23 and 5.94 respectively. From Table 3 it is seen that the mean scores for epileptic and non-epileptic normal boys are 15.9 and SD is 7.75. Similarly the mean and SD for epileptic and nonepileptic normal girls are 15.27 and 9.37 respectively. The F-ratio in Table 5 indicates that there is a significant difference between epileptics and non-epileptic normals. Here too contribution of sex variable and its interaction effect with epilepsy could not be found out. Thus, from Table 2 it can be clearly said that non-epileptic normals have significantly more Benton Visual Retention scores as compared to epileptics. Visuospatial skills were reported to be poor in epileptic patients (Schwartz and Dennerll, 1970; Morgan and Groh, 1980; Helmstaedter et al., 1991). This study is in line with the above findings. Summary: The statistical values yielded the fact that significant degrees of differences are existing between epileptics and non-epileptic normals with regard to the different areas of cognitive functioning. Impairment in the cognitive abilities and a decline of intellectual functions has been documented for many years as a complication of epilepsy. Since the early 20th century investigators have recognized an association between impaired cognitive and intellectual functioning and epilepsy (Turner, 1907). Especially, since the 1950s there has been extensive discussion of intellectual changes in epilepsy. However, most of the studies were conducted on institutionalized patients. Moreover, well-controlled systematic studies were lacking. Studies conducted after 1970s are usually controlled studies. Even then very few detail systematic studies are available. Findings are mainly in favor of impairment in sensory process, attention and concentration, learning and memory language skills, perceptual abilities, conceptual process, reasoning and motor skills. From the results it is seen that in all the areas of intelligence, attention, memory, social maturity and visual retention capacity there are significant differences between the epileptics and non-epileptic normals. But no significant difference has been noted between the sexes and the interaction effect of sex and epilepsy in all these areas. Cognitive Profile of Epileptics

In case of Immediate memory, no significant difference has been noted between epileptics and non-epileptic normals, between sexes and between the interaction effect of sexes and epilepsy. Conclusion: The findings of the present study have enlightened a concrete fact that epilepsy does affect the cognitive functioning of an individual. The highlight points of the present study are:- a) The general intellectual capacities specifically in the dimensions of attention, memory, visual retention are negatively affected by epilepsy. b) The overall rate of social maturity prompts the epileptics to feel lagging behind the norms of expected social behaviour of their counterparts. c) Organic deficiency owing to epilepsy has greater detrimental effect in terms of remote and recent memory. d) The basic visuo-motor coordination is poorer in epileptics compared to non-epileptic normals. e) Epilepsy was found to be free of sex variable effect in socio-cognitive dimensions of behaviour. Implication of the Study: Considering the valuable findings of the present study a need has been felt to be aware of such facts in our life and to develop strategies to combat such difficulties in the life of the epileptics. Improvements in the process will include I. Developing more intensive assessment procedures for earlier detection of epileptic focus in individuals and the degree of damage it can cause in the cognitive areas. II. Advanced pharmacological intervention either to prevent or to mend such damages. III. Attitudinal improvement to be supportive towards these individuals in social life. IV. Individual related appropriate therapeutic intervention to overcome the lapses caused by epilepsy in each of cases. V. Individually catered neuropsychological rehabilitation programme for the epileptic children should be formulated to combat located deficiencies of the present study. References: Aikia, M., Kalviainen, R., & Riekkinen, P.J. (1992). Verbal Learning and Memory in newly diagnosed partial epilepsy. Epilepsy Research, 22(2), 157-164. Aldenkamp, A.P., Alpherts, W.C.J., Dekker, M.J.A., & Overweg, J. (1990). Neuropsychological aspects of Learning disabilities in epilepsy. Epilepsia, 31 (Suppl 4), S9-S20. Alwash, R. H., Hussein, M. J. and Matloub, F. S. (2002) Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan, Seizure (Sept) Vol 9(6) , 412-416. Bagley, C. (1971). The social psychology of the child with epilepsy. London : Routledge. Bender, L. (1938) A visual motor Gestalt test and its clinical use. American Orthopsychiatric Association. Research Monograph, No.3. Benton, A. L. (1963) A Revised Visual Retention Test. Psychological Corporation, NY. Brown, S., Betts, T., Chadwick, D., Hall, B., Shorvon, S. and Wallace, S. (1993) ‘An epilepsy needs document’, Seizure 2:91-103. 138 Sanyal and Rajagopalan

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Loiseau, P. and Signoret, J. L. (1988) ‘Memory and Epilepsy’, in M. R. Trimble, and E. H. Reynolds (eds) Epilepsy, Behaviour and Cognitive Function, Chichester: Wiley. Malin, A.J. (1971) Indian Adaptation of Vineland Social Maturity Scale. Lucknow, Indian Psychological Corporation. Mayeux, R., Brandt, J., Rosen, J. and Benson, D. F. (1980) ‘Interictal memory and language impairment in temporal lobe epilepsy’, Neurology 30: 120-5. Mirsky, A. F., Primac, D. W., Marsan, C. A., Rosvold, H. E. & Stevens, J. R. (1960) ‘A comparison of the psychological test performance of patients with focal and non-focal epilepsy’, Experimental Neurology, 2, 75-89. Morgan, A. M. B. and Groh, C. (1980) ‘Visual perceptual deficits and young children with epilepsy’, in B. M. Kulig, H. Meinardi and G. Stores (eds) Epilepsy and Behaviour 79, Lisse: Swets and Zeitlinger. Nolan, Melinda. A., Redoblado, Antoinette. M., Lah, Suncica., Sabaz, Mark., Lawson, John. A., Cunningham, Anne. M., Bleasel, Andrew. F. and Bye, Ann. M. E. (2002) Intelligence in childhood epilepsy syndromes. Journal of Epilepsy, Vol 11(6), Dec. Pershad, D. and Wig, N. N. (1988). Revised Manual for PGI Memory Scale (PGIMS). National Psychological Corporation, Agra. Ratti, M., Galimberti, C., Manni, R. and Tantara, A. (1992) ‘Remote memory impairment in temporal lobe epilepsy’, Seizure 1 (suppl. A): 14/11. Ross, E. & West, P. B. (1978) Achievements and problems of British two year olds with epilepsy. In Meiardi H, Rpwan A.J : Advances in Epileptology Psychology and New Diagnostic Approaches. Amsterdam: Swets & Zeitlinger. Roy, M. (1994) Neuropsychological study of epileptics. Unpublished MMSP dissertation, Ranchi: Ranchi University. Sass, K. J., Sass, A., Westerveld, M., Lencz, T., Rosewater, K. M., Novelly, R. A., Kim, J. H. and Spencer, D. D. (1992a) ‘Russell’s adaptation of the Wechsler Memory Scale as an index of hippocampal pathology’, Journal of Epilepsy 5: 24-30. Sass, K. J., Sass, A., Westerveld, M., Lencz, T., Novelly, R. A., Kim, J. H. and Spencer, D. D. (1992b) ‘Specificity in the correlation of verbal memory and hippocampal neuronal loss: dissociation of memory, language and verbal intellectual ability’, Journal of Clinical and Experimental Neuropsychology 14: 662-72. Schwartz, M. I. & Dennerll, R. D. (1970). Neuropsychological assessment of children with and without questionable epileptogenic dysfunction. Perceptual and Motor Skills, 30, 111- 121. Seidenberg, M., Beck, N., Geisser, M., Giordani, B., Sackellares, J. C., Berent, S., Dreifuss, F. E. & Boll, T. J. (1986) Academic achievement of children with epilepsy. Epilepsia, 27, 753-759. Stores, G. (1973) Studies of attention and seizure disorders. Developmental Medicine and Child Neurology, 15, 376-382. Taylor, J. (ed.) (1958) Selected Writings of John Hughlings Jackson, Vol. 1: On Epilepsy and Epileptiform Convulsions, New York, Basic Books. Turner, W. A. (1985) Epilepsy a study of the idiopathic disease. London: MacMillam, 1907. In Giordani, B., Berent, S. A., Sackellares, J. C., Rourke, D., Seidenberg, M., O’Leary, D. S., Dreifuss, F. E. & Ball, J. T. Intelligence test performance of patients with partial and generalized seizures. Epilepsia, 26, 37-42. Wechsler, D. (1943) The Measurement of Adult Intelligence. Baltimore : The Williams & Wilkins Company. Wechsler, D. (1949) Manual of Wechsler Intelligence Scale for Children, New York : The Psychological Corporation. 140 Sanyal and Rajagopalan

SIS-I and Rorschach Diagnostic Indicators of Attention Deficit and Hyperactivity Disorder Ruchi Jain, Beer Singh, Sandhyarani Mohanty and Rakesh Kumar The present study makes an effort to identify the Rorschach and SIS-I diagnostic indicators of ADHD. The study was conducted on a sample of 224 children in the age range of 6-11 years drawn from various schools of Baraut (U.P). Participants were categorized into two groups - ADHD (n=111) and control (n=113). Rorschach and SIS-I were individually administered on each participant and the response pattern of ADHD and normal children on two projective measures was compared. Frequency data of scored indices were transformed into percent scores (taking total number of responses as denominator) and total and transformed scores of the ADHD and Control groups were compared (using t-test) for identifying the discriminating indices. The sensitivity of both tests in identifying patients of ADHD was also compared. Several Rorschach indices such as, M,D, FC,F+, and A, were found significant in differentiating normal children from ADHD. The SIS-I Results revealed that both the tests are sensitive in discriminating the ADHD children from normal controls. Findings have been discussed in the light of available research evidences. Somatic Inkblot Series-I was developed in 1960 (Cassell, 1980) to extend the Rorschach’s concept that ambiguous and semi-ambiguous visual stimulus evoke spontaneous responses associated with body images and personality dynamics. SIS provides images in three forms - on cards, in a booklet and on videotapes/CD. Altogether five forms have been evolved: SIS-I (20 cards), SIS-II Booklet 62 images, SIS-I Video, SIS-II Video/CD and SIS living images. The review of literature on SIS revealed that SIS-II (booklet form) has attracted more researches followed by the card form. SIS-II has been used in psychotics and neurotics (Rathee et. al. 1995, Pershad et al. 1997; Rathee et. al. 2002), schizophrenics and depressives (Pershad & Verma 1995), psychiatric patients (Verma et. al. 1994, Verma et. al. 1996; Singh and Dubey 1997; Singh et. al. 1997), speech defects (Nehra et. al. 1997), and murderers (Singh et. al. 2000). The meta-analysis of SIS-II clearly indicates its power in discriminating various groups (Kumar, 2000). SIS-I has been employed in coronary patients (Dubey et al. 1994), drug addicts (Mukhopadhyay, et al. 1996; Mitra and Mukhopadhyay, (1996), normals (Rathee and Singh, 1996) obese patients (Cinzia and Roberto, 1998), chronic schizophrenics (Kumar et. al. 2001), achondroplasia and traumatically shortened extremities (Khromov, 2001), and militants (Saldanha, 2002). The extensive survey on SIS revealed that only a few studies have been conducted on children. Pandey et.al. examined the SIS-II responses of normal children and compared it with those of adolescents and adults. In the light of this, the index study was designed to establish normative data on SIS-I on children and to delineate diagnostic indicators for ADHD. Ruchi Jain, Research Scholar, Beer Singh, Reader & Head, Department of Psychology, D.J.College, Baraut, Sandhyarani Mohanty, Research Officer and Rakesh Kumar, Senior Clinical Psychologist, Institute of Mental Health and Hospital, Agra, email: pastlifeindia@yahoo.co.in (This paper is a part of the Ph.D.thesis in psychology awarded to Ruchi Jain in 2004 by CCS University, Meerut.) Key Words: Rorschach, SIS-I, ADHD.

Rorschach Inkblot test is an important and psychometrically validated tool for performaning psycho-diagnosis. Hundreds of researches have explored its applications in a variety of conditions. Several scoring systems have been evolved to aid scoring, interpretation and diagnostic formulation. A comprehensive review of literature on Rorschach indicated that researchers are still striving to develop indices for various clinical conditions. The identification of diagnostic indicators on Rorschach for attention deficit disorder would not only enhance the diagnostic utility of the Rorschach but would also provide a criterion for validating the SIS-I ADHD indices. The present study was planned to explore the SIS-I and Rorschach diagnostic indicators of Attention Deficit And Hyperactivity Disorder among children and to cross validate ADHD indices on SIS-I and Rorschach. Method : Sample : The sample consisted of 224 subjects drawn from 6 schools located in Baraut near New Delhi. Subjects with the history of epilepsy, mental retardation, and physical illness were excluded from the study. Subjects were consented for the study and those who were cooperative were included in the study. The sample characteristics is given in Table 1. Table 1 Sample Characteristics Characteristics Control ADHD (n=113) (n=111) Age 6-8 years 9-11 years Gender Boys Girls Tools : The background information about the participants was collected through a Personal Data Sheet specially designed for the present study. Rorschach Inkblot Test (RIT) consisting of the standard 10 inkblots and the Somatic Inkblot Series-I (SIS-I) consisting of 20 cards was used to identify the pathology specific projective responses. The scoring of the RIT was done as per the system of Beck et.al. (1961) and SIS-I protocols were scored according to the system developed by Cassel and Dubey (1997, 2003). Special attention was given to include those Rorschach indices, which were similar to the SIS-I indices. This was done in order to compare the diagnostic efficacy of the two tests. Procedure : Subjects were approached individually by the investigator. After establishing rapport with the subject, personal information sheet was completed. This was followed by individual administration of Rorschach Inkblot test and SIS-I in a distraction free environment in one or two sessions depending upon the circumstances. Jain et. al.

Statistical Analysis : To analyze the pattern of responses on Rorschach and SIS-I in normal and clinical groups, mean, standard deviation and percentages of scoring indices were computed on total sample and sub-samples. Because of low or zero responses on many indices median test could not be used. A thorough review of non-parametric statistics did not result in any viable alternative non-parametric statistical technique. To overcome this difficulty it was decided that the scores on the indices be converted into percentage scores by taking total number of responses as denominator. Hence the raw scores were transformed into percentage score and compared through t-test. For correlating the common indices on Rorschach and SIS-I, rank order correlation was considered appropriate. Because of multiple ties on many indices, it had to be dropped and finally Pearson’s product moment correlation was calculated on percent scores of the scoring indices. Results and Discussion : The descriptive statistics of various Rorschach indices in control and clinical groups and the results of between group comparisons using t-test have been presented in table 2. It is evident from the table that obvious Detail (D), Human Movement (M), Csum, Form-colour (FC) responses, Percent Good Form (F+%), Animal Percent (A%) and Popular (P) responses significantly differentiated the groups. On remaining indices, statistically significant differences did not emerge Examination of the mean scores of the statistically significant indices revealed that clinical group has significantly lower responses on obvious Detail, Human Movement, good Form percepts, Animal content, and Popular responses. Csum and FC responses are significantly higher in clinical group as compared to the control group. A similar statistical analysis was done of the SIS-I data. The mean score and SD of various indices of SIS-I in control and clinical groups have been displayed in table-3. The control and clinical groups were also compared on each SIS-I index using t-test and the obtained statistics has also been given in the same table. Attention Deficit Hyperactivity Disorder (ADHD) is clinically characterized by hyperactivity, perceptual motor impairment, emotional ability, general co-ordination deficit, distractibility, poor concentration, impulsivity, disorders of memory and thinking, specific learning disabilities and so on (Kaplan & Sadock, 1985 p. 743). The inkblots provide an unique opportunity to an individual to reveal his personality through the phenomena of projection. The characteristic findings on two inkblots are discussed below. Twenty-three Rorschach indices were scored and examined in the present study. However, to facilitate the diagnostic understanding, theoretically related indices have been grouped together. In this way, findings related to thirteen classes of Rorschach indices have been discussed below. SIS in Attention Deficit and Hyperactivity Disorder

Table 2 Mean, S.D. and t-values of Rorschach Indices in Clinical and Control Group Rorschach Indices Controls ADHD t-Values (n=113) (n=111) Mean S.D. Mean S.D. Total Responses (R) 20.95± 6.23 21.44± 9.41 .46 Whole Responses (W) 12.99± 9.09 14.41± 14.28 .89 Obvious Details (D) 76.57± 10.52 72.26± 16.78 2.30* Rare Details (Dd) 9.99± 0.75 13.27± 15.11 1.87 Movement (M) 6.34± 10.56 3.79± 8.09 2.02* Csum 4.40± 8.89 8.95± 11.13 3.38** Color ( C) 0.46± 2.03 1.11± 3.34 1.75 Color-Form (CF) 2.19± 5.76 3.29± 5.60 1.46 Form-Color (FC) 1.86± 5.38 4.28± 7.48 2.77** Vista (V) 3.32± 6.26 3.98± 8.06 .68 Shading (Y) 5.49± 9.94 8.08± 10.98 1.85 Texture (T) Affective Ratio (Afr) 3.75± 1.79 3.74± 1.94 .04 Human (H) 15.67± 12.62 15.02± 13.61 .37 Human Detail (Hd) 2.85± 5.23 3.60± 8.18 .82 Anatomy (At) 4.98± 10.70 5.93± 13.71 .58 Good Form (F+%) 54.75± 17.28 44.59± 18.52 4.24** Animal (A%) 51.31± 19.78 44.75± 24.66 2.19* Popular (P) 13.99± 7.58 11.74± 7.94 2.17* Lambda (L) 23.42± 33.53 19.31± 26.28 1.02 White Space (S%) 1.37± 2.72 1.64± 3.28 .66 T/IR 158.04± 112.89 168.94± 166.22 .57 Rejection of Cards 1.31± 3.68 2.59± 7.74 1.58 * Significant at .05 level ** significant at .01 leve Total Number of Responses (R) : The R on Rorschach is indicative of scored productivity (Beck et.al. 1961). This index failed to yield statistically significant difference between groups. Therefore, total number of responses as such cannot be regarded as an important index in differentiating ADHD from controls. As total productivity on Rorschach is also considered as an indicator of the intellectual maturity, the findings imply that ADHD children are intellectually similar to their counterpart normal children. Table 3 Jain et. al.

Mean, S.D. and t-values of SIS-I Indices in Clinical and Control Group SIS-I Indices Control ADHD t-values (n=113) (n=111) Mean S.D. Mean S.D. Total Responses ( R) 37.41 11.06 35.66 13.81 1.04 Human (H) 17.54 11.81 16.78 13.06 .45 Animal (A) 31.15 17.55 28.94 18.98 .90 Anatomy (At) 12.99 12.27 16.77 15.95 1.99* Movement (M) 2.74 4.58 2.15 4.67 .94 Sex 0.12 0.72 .14 .76 .26 Most Typical (MT) 5.58 3.41 4.91 3.49 1.45 Typical (T) 59.61 17.34 46.26 16.56 5.88** Atypical (AT) 34.61 16.75 47.44 16.74 5.73** Rejection of Images 1.65 4.50 4.18 9.90 2.46* * Significant at .05 level ** significant at .01 level It is obvious from this table that Anatomy (At), Typical (T), Atypical (AT) and Rejection of Images (Rej) significantly differentiated the groups. Clinical group is found to have high Anatomy, low Typical, high Atypical and more Rejection of images than the control group. To examine the compatibility of the Rorschach and SIS-I, correlation between the scores of the two tests on common indices were computed and the obtained results have been displayed in table 4 Table 4 Co-efficient of Correlation Between Rorschach and SIS-I in Normal Subjects Indices Correlation (r) Significance R 0.63 .01 H 0.52 .01 A 0.44 .01 F+% 0.40 .01 P 0.13 n.s. M 0.63 .01 At 0.66 .01 Rej 0.34 .01 The correlation between the two test on every index except for Popular/Most Typical was found to be statistically significant. SIS in Attention Deficit and Hyperactivity Disorder

Whole Responses (W) : Of various location indices, W is probably the most frequently and widely investigated location score. W responses are given in greater frequency for cards I, IV, V and VI because these cards are more solid and represent the form of unbroken blots. The comparisons of W did not yield significant differences between ADHD and normal children indicating that this index on Rorschach is not important to discriminate the control and clinical groups. Obvious Details (D) : The D response according to Rorschach (1942) indicates an ability to perceive and react to clear and distinct characteristics of world. Generally, D responses are easier to give than W responses because they represent the easiest perceptual cognitive mode to act when faced with ambiguity. Because of this, usually there is a preponderance of ‘D’ responses in a protocol over other location indices. Persons having stress, anxiety and maladjustment yield a low proportion of D responses. The results of Rorschach revealed significantly lower D responses in the clinical (ADHD) group. The lower D in clinical group is indicative of maladjustment in the subjects. Rare Details (Dd) : Dd responses are least frequent in a test protocols. In the index study, the comparison groups did not differ significantly on this index. Good Form Responses (F+%) : In the present study, F+% is found to be significantly lower in clinical group than the control group. The F+% is one of the important index that differentiated clinical group from the control group. Distractibility, poor concentration, disorders of memory and thinking in children with ADHD probably contributed to lowered good form responses in children with ADHD. Bartells & Solanto (1995) also found low good Form response in ADHD. Thus, the low F+% in ADHD children is congruent with their impaired cognitive faculties. The pure form percept is the most common determinant in the test. The pure form responses are interpreted in terms of its quality, that is, good form (F+) and poor form (F-). According to Beck and Molish (1967) the good form response indicates that the examinee has respect for reality of the environment. Rorschach (1942) assigned it a cornerstone position in his overall thinking about personality. He sets up four basic requisites: (a) ability to centre the attention, making possible clear perception; (b) possession of clear mental pictures, (c) power to bring those clear memory pictures into consciousness; (d) ability to select, from among the memory pictures, that one which resembles the stimulus most, a process that again depends on control of the perception and on critical interpretation. It also indicates adequate affective delay or control necessary for occurrence of the form response. According to Beck & Molish (1967) F+ findings generally vary concomitantly with two chief personality factors : namely, intellectual endowment and affective state. Human Movement (M): In the present study, clinical group produced significantly lower M than the control group. The hyperactivity in children with ADHD as a whole seems to have contributed Jain et. al.

to lower M responses. Earlier researches such as that of Bartells & Solanto (1995) also reported low M in ADHD. Rorschach (1942) suggested that M responses indicate the phenomena of “internalization”. The M responses reflect the ability of an examinee to handle more deliberate and sophisticated experience in a way that can be controlled emotionally. Beck (1944) reported that M responses indicate awareness towards the external world and reflect some conflicts or emotion, which do not get obvious expression in the world of reality. Cocking, Dana & Dana (1969) found that M responses are related with intellect, fantasies and time estimation. Singer, Meltzoff & Goldmann (1952) cited Rapaport’s (1946) concept of fantasy as resulting from inhibition of action directed toward immediate need gratification. Singer et.al. (1952) obtained significant increase in M responses following a period of motor inhibition suggesting a correlation between motor and sensory processes. Thus, the observed low M response in the Rorschach protocols of ADHD children in the present study is indicative of the above-mentioned psychological deficits in these children. Werner (1948) developed a sensory tonic theory of motor activity to apply to the function of M response in personality structure. He demonstrated that in a feebleminded group hyperactive children gave significantly less movement responses of all types in Rorschach than did a less active group. Subjects who produce high M resort to longer motor delays in their social adjustment (Frankle, 1955; Mirin, 1955; Tolman & Meyers, 1956). Colour Responses (C, CF, FC) : An examination of colour responses in the index study revealed that clinical group produced significantly higher colour responses. Higher colour determined responses in clinical groups is also one of the important finding on Rorschach test. Impulsivity in children with ADHD is one of the core diagnostic features, which is also revealed by Rorschach through higher colour determined responses. Moreover, children with ADHD have lower M responses, which serve to inhibit the motor acts. According to Rorschach (1942) chromatic color responses indicate affectivity or emotional excitability. Beck & Molish (1967) stated that Csum, the sum of color responses, is an index of affective energy available for responding to the environment. The manner in which this energy is expanded is a function of the total ego structure and of the inward balance afforded by M. In healthy individuals, Csum projects the energy and drive available for coping with adversities and in order to manipulate the environment, adjust to change and react to stress. The lower Csum is indicative of a more phlegmatic and rigid effort at coping with the demands of the environment. In children, colour responses indicate impulsivity. Variations in Light (V, Y, T) : This determinant is found in one of three variations: vista (V), flat gray (y) and texture (T) (Beck et.al. 1961). Vista responses are shading responses based upon dimensionality. The diffuse shading responses (Y) are more common and frequent than V and T. These indices on Rorschach were not found significant in discriminating ADHD from controls. SIS in Attention Deficit and Hyperactivity Disorder

Affective Ratio (Afr) : Beck & Molish (1967) reported that Afr as an index of readiness to respond to the challenges of exciting events. In the present study this index was not found sensitive to differentiate the ADHD group from control group. Animal Responses (A%) : Animal content is the single major class of responses in Rorschach test (Wedemeyer, 1954; Neff & Glaser, 1954). Beck & Molish (1967) reported that A% is an index of stereotype and adaptivity. An excess of A% indicates constriction and self-guarding. Low A% indicates the idiographic character of the person who perceives objects of the environment in his own peculiar way. Animal content in the index study is found to be lower in clinical group than control group. Lower A% in ADHD reflects their tendency to perceive the objects in their own peculiar ways. Anatomy (At) : Anatomical responses indicate excess preoccupation with bodily concerns without any physiological illness. The person releases his emotions towards stress through these preoccupations. Anatomical responses also indicate concern with destructive impulses (Phillips & Smith, 1953). However, Anatomical index failed to discriminate between the clinical and control group. Popular Responses (P) : According to Beck & Molish (1967) P responses reflect the ability to participate in popular thinking within a specific culture or the conformity of the individual’s thinking in a group. Several investigators (Loosli-Usteri, 1938; Kerr, 1934; Diethelm, 1933; Pfister, 1925; Oberholzer, 1931; Hertz, 1946; Piotrowski, 1950) described the concept of P as an evidence individual’s popular thinking. The clinical group as a whole produced lower P than the control group. It seems that the children with ADHD especially lack in group conformity in a particular culture. Rejection : According to Bohm (1958) card rejection is the result of an inhibition or blocking of the flow of thought. Rejection is only a shock phenomena in most cases and offers an index of neurosis. In the present study, rejection is not found to be significantly different in comparison with normal and neurotics. Findings on SIS-I : Total Number of Responses (R) on SIS-I was also found significantly different in the two comparison groups. Animal Responses (A) : SIS-I evokes lesser animal content than Rorschach because of the anatomy-laden nature of stimulus material of the SIS-I. The results of the index study revealed that this content category failed to differentiate the two comparison groups. Hence, this scoring index is not powerful enough to discriminate the groups. Anatomy (At) : The results of SIS-I in the index study revealed that clinical group has significantly higher Anatomical responses than control group. The anatomical responses on SIS-I have potential to discriminate the ADHD children from normal children. Jain et. al.

Movement Responses (M) : The M responses on SIS-I failed to discriminate the comparison groups. Here, it is important to mention that this index on the Rorschach significantly differentiated the ADHD from normal children. Sex Responses : This scoring index on SIS-I also did not prove to be an indicator as none of the comparison group differed significantly on this index. Most Typical Responses (MT) : The MT responses are like popular responses on Rorschach. MT responses are not significantly different in the two comparison groups. The P responses on Rorschach were, however, significantly differentiated the ADHD children from normal children. Typical Responses (T) : The Typical responses on SIS-I are like F+ responses on Rorschach. The Typical responses in the index study are significantly lower in clinical group than control group. On Rorschach low F+% emerged as a powerful scoring index in discriminating the children with ADHD from controls. Thus, this SIS-I index appears to prove as diagnostic indicator compatible to Rorschach. Rejection of Images : The results revealed that on SIS-I, clinical group rejected more cards than control group. The Rejection of the cards on SIS-I appeared to be relatively more useful scoring index than Rorschach in discriminating the groups. Correlation Between Rorschach and SIS-I Indices : Kaur & Verma (1998) correlated Rorschach and SIS-II in a mixed group of psychiatric patients. They found significant correlation for MT, T, At, M, H and A responses. Rathee et.al. (1998) correlated Rorschach and SIS-II in schizophrenics, affective psychosis and unspecified psychosis. In schizophrenia, significant correlations were obtained for R, MT, H, A and Rejection. In affective psychosis signification correlation s were obtained for T, AT and M; and in unspecified psychosis for R, At, H, A, and Rejection. Kumar, Mohanty & Kumar (2003) correlated Rorschach and SIS-I in manic patients. They found all the correlations significant except for MT index. In the index study, Rorschach and SIS-I have positive and significant correlations in normal subjects on all indices except MT. Conclusions : The following indices on the Rorschach test may serve as diagnostic indicators for ADHD in clinical settings (i) Low human movement (ii) High Csum (iii) High FC responses (iv) Low F+ (good form) responses (v) Low animal content (vi) Low popular responses SIS in Attention Deficit and Hyperactivity Disorder

The following were found diagnostic indicators on SIS-I for ADHD in clinical settings : (i) Low typical responses (ii) High atypical responses (iii) High card rejection The significant correlations between common indices of Rorschach and SIS-I suggest that the SIS-I is capable in providing diagnostic information similar to that of the Rorschach and provides some empirical support to the conceptualization that SIS is further development of Rorschach test. References: Bartell, S.S. and Solanto, M.V. (1995). Usefulness of the Rorschach Inkblot Test in Assessment of Attention Deficit Hyperactivity Disorder Percepuo- Motor Skills, 80, 521-41. Beck, S.J., Beck, A.G., Levitt, E.E. and Malish, H.B. (1961). Rorschach’s Test Basic Processes. New York : Gurne & Strattons. Beck, S.J. (1944) Rorschach’s Test Vol I Basic Process New York : Grune & Stratton. Beck, S.J. and Molish (1967). Rorschach’s Test Vol II. A Variety of Personality Pictures. New York : Grune & Stratton. Bohm, E. (1958) A Textbook in Rorschach Test Diagnosis (Tr. by A. Beck & S.J. Beck) New York : Grune & Stratton. Cassell, W.A. (1980). Body Symbolism and the Somatic Inkblot Series. Alaska, Aurora Publication. Cassell, W. A. and Dubey, B. L.(1997) SIS-II Somatic Inkblot Series-II Manual. SIS Center, Anchorage, Alaska (USA). Cassell, W. A. and Dubey, B. L.(2003) Interpreting Inner World Through Somatic Imagery. SIS Center, Anchorage, Alaska (USA). Cinzia, S. and Roberto, F. (1998). The SIS-I and Body Image Evaluation in Subjects Suffering from Serious Obesity. SIS Journal of Projective Psychologyh & Mental Health, 5, 105- 113. Cocking R.R., Dana, J.M., and Dana, R.H., (1969) Six Constructs to Difine Rorschach M : A Response . Journal of Projective Techniques and Personality Assessment, 33, 322- 323. Diethelm, O. (1933) The Personality Concept in Relation to Graphology and the Rorschach Test. Research Nerous. and Mental. Diseases. 14, 278-286. Dubey, B.L., Mishra, M., Dwivedi, C.B., and Mishra, N. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Series - II and Rorschach. SIS Journal of Projective Psychology & Mental Health, 1, 19-26. Frankle, A.H. (1955). Rorschach Human Movement and Human Content Responses as Indices of the Adequacy of Interpersonal Relationship of Social work Students. Unpubl. Doctoral Dissertation University of Chicago. Hertz, M.R. (1946) The Scoring of Rorschach Inkblot Method as Developed by the Brush Foundation. Rors. Res. Exch., 6, 16-22. Kaplan, H.I. and Sadock, B.J. (1985). Synopsis of Psychiatry, Baltimore: Williams & Wilkins. Kaur, R.P., and Verma, S.K. (1998). A Correlational Study of Selected Rorschach and SIS-II Variables in Psychiatric Patients. SIS Journal of Projective Psychology & Mental Health, 5, 115-118. Kerr, M. (1934) The Rorschach Test Applied to Children. British Journal of Psychology., 25, 170- 185. Jain et. al.

Khromov, A. (2001). Psychological Characteristics of Subjects with Achondroplasia and Traumatically Shortened Extremities. SIS - Journal of Projective Psychology & Mental Health, 8, 53-64. Kumar, R. (2000). Meta Analysis of the Findings on SIS-II. SIS Journal of Projective Psychology & Mental Health, 7,141-147. Kumar, S., Singh, R., and Mohanty, S. (2001). A Study of Somatic Inkblot Series-I in Hospitalized Male Chronic Schizophrenics. SIS Journal of Projective Psychology & Mental Health, 8, 31-37. Kumar, S., Mhohanty, S., and Kumar, R. (2003) SIS-I Profile and its Correlation with Rorschach in Manic Patients, SIS Journal of Projective Psychology and Mental Health, 10. Loosli-Usteri, M. (1938) Le Diagnostic Individual Chez Penjant de Moyen du Test do Rorschach Paris, 2 ed. P.36. Lotsof, E. (1953). Intelligence Verbal Fluency and Rorschach Test. Journal of Consulting and Clinical. Psychology, 17, 21-24. McCully, R.S. (1961). Human Movement in the Rorschach Materials of a Group of Preadolescent Boys Suffering from Progressive Muscular Loss. J. Projective Technique, 25, 205-211. Mirin, B. (1955). The Rorschach Human Movement Response and Role Taking Behaviour. Journal of Nervous and. Mena. Diseases, 122, 270-275. Mitra, G., and Mukhopadhyay, A. (1996) SIS and Social Anxiety - An Assessment of Personality Factors of drug Addicts. SIS Journal of Projective Psychology & Mental Health, 3. Mukhopadhyay, A., Banerjee, S., and Mitra, G. (1996). A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS Journal of Projective Psychology & Mental Health, 3, 33-41. Neff, W.S., and Glaser, N.M. (1954) Normative Data on the Rorschach. Journal of Psychology, 37, 95-104. Nehra, A., Raghunathan, M., Verma, S.K. and Mann, S.B.S. (1997). Recognition of Psychological Problem in Patients Suffering from Speech Defects with the help of SIS-II. SIS Journal of Projective Psychology & Mental Health 4, 143-151. Oberholzer, E.Zur. (1931) Differential Diagnose Psychischer Folgezustande Nach Schadeltraumen Mittcls Des Rorschach & Chen Formdeutversuchs. Z. Ges. Neural. Psychiat., 136, 596-629. Pershad, D., and Verma, S.K. (1995) Diagnostic Significance of Content Analysis of SIS-II. SIS Journal of Projective Psychology & Mental Health., 2, 141-149. Pershad, D., Verma, S.K. and Bhagat, K. (1997). Body Image Distrubances in Psychiatric Cases. SIS Journal of Projective Psychology & Mental Health, 14, 75-84. Pfister, O. (1925) Ergebnisse des Rorschach’ schen Versuches bei oligophrenen. Allgem. Zeitschr. F. Psychiatric, vol 82, PP. 198-223. Phillips, L., & Smith, J.G. (1953) Rorschach Interpretation Advanced Technique. New York : Grune & Stratton. Piotrowski, Z.A. (1950) A Rorschach Compendium Revised and Enraged. Psychiatric Quarterly, 4,543-596. Rapaport, D. (1946). Diagnostic Psychological Testing. Vol II Chicago : New York. Rathee, S.P., Pande, V. and Singh, A. (1995).Diagnostic Efficacy of Somatic Inkblot Series-II Among Psychiatric Patients of Armed Forces : SIS Journal of Projective Psychology & Mental Health, 2, 61-66. Rathee, S.P. and Singh, A. (1996). A Comparative Study of Male and Female on Somatic Inkblot Series-I. SIS Journal of Projective Psychology & Mental Health., 3, 43-49. SIS in Attention Deficit and Hyperactivity Disorder

Rathee, S.P., Pardal, P.K., and John, T.R. (2002). Diagnostic Value of SIS-II Among Sub-Groups of Psychotic and Neurotic Patients of Armed Forces. SIS Journal of Projective Psychology & Mental Health, 9,38-48. Rorschach, H. (1942) Psychodiagnostic, New York : Grune & Stratton. Saldanha, D. (2002). Profile of Militants: An Attempt to Study the Mind of Militants. SIS Journal of Projective Psychology & Mental Health, 9, 23-32. Singer, J.L., Meltzoff, J. and Goldman, G.D. (1952). Rorschach Movement Responses Following Motor Inhibition and Hyperactivity. Journal of Consulting and Clinical. Psychoogy., 16, 559-564. Singh, A.R., Dubey, B.L., and Banerjee, K.R. (1997). Prognostic utility of Somatic Inkblot Series- II. SIS Journal of Projective Psychology & Mental Health 4, 141-144. Singh, A.R. and Dubey, B.L. (1997). SIS-II Profile of Drug and Alcohol Dependent Cases. SIS Journal of Projective Psychology & Mental Health, 4, 69-74. Singh, A.R., Dubey, B.L., Sahu, L.M., and Banerjee, K.R. (2000). SIS-II Profile of Murderers. SIS Journal of Projective Psychology and Mental Health. Tolman, R.S. and Meyer, M.M. (1956). A Study of Patient Identification from Rorschach Records and Therapists Iudgements Journal of Projective Techniques, 20, 48-51. Verma, S.K., Pershad, D., and Nehra, R. (1994). Cross- Validation of SIS-II in Psychiatric Population. SIS Journal of Projective Psychology & Mental Health, 1, 15-18. Verma, S.K., Pershad, D., Bhagat, K., and Kaur, R. (1996). Interdependence of SIS Variables with Personality Traits in Psychiatric Cases. SIS Journal of Projective Psychology & Mental Health, 3, 51-58. Wedemeyer, B. (1954) Rorschach Statistics on a Group of 136 Normal Men. Journal of Psychology, 37, 51-58. Werner, H. (1948). Comparative Psychology of Mental Development, Chicago: Follett. Wittenborn, J.R. (1950). Statistical Tests of Certain Rorschach Assumptions: the Internal Consistency of Scoring Categories. Journal of Consulting and Clinical Psychology, 14, 1-19. Jain et. al.

Effect of Psychological Intervention Through SIS-I Images on Police Personnel S.N. Dubey and B.L.Dubey Police personnel are more likely to witness traumatic situations and live in hard life. The deprivation of family is known factors leading to depression and stress. Lot many police personnel are not able to manage their stress and develop psychological symptoms. The present study was tried on 50 police men. They were administered SIS test along with Progressive Muscular Relaxation (PMR), Shaw Asana and GSR Bio-feed back for 10 days. The results suggest significant increase in Most Typical (MT) and Human responses (H) and decrease in Rejection of images (Rej), Atypical (AT) and Pathological (PAS and HAS) responses. The findings further indicate the effect of intervention thru Progressive Muscular Relaxation (PMR) and Shaw Asana. It is suggested that such Psychological Intervention with PMR, Shaw Asana, GSR Bio-feed back and SIS may help in maintaining their psychological profile. Police Personnel generally live in hard conditions. They are away from their family for months together. The deprivation of family is known factors leading to depression and anxiety (Dubey, 1978). Though it is part of their duties but except a few many are not able to manage their stress. The study is an attempt to help them in managing their stress. Somatic Inkblot Series Card Form was administered to 50 Police Personnel located in Ayodhya. They were also prepared to learn the application of Progressive Muscular Relaxation (PMR), Shaw Asana and GSR Bio-feed back for 10 days. The analysis is based on the comparisons of the responses on SIS-I on first and 10th day. The Findings suggest significant increase in Most Typical (MT) and Human responses (H) and decrease in Rejection of images (Rej), Atypical (AT) and Pathological (PAS and HAS) responses. The findings further indicate the effect of intervention thru Progressive Muscular Relaxation (PMR) and Shaw Asana. The SIS images have also proved to be an adjunct to psychotherapy and helps in releasing the unprocessed material. It is suggested that such Psychological Intervention with PMR, Shaw Asana, GSR Bio-feed back and SIS at regular interval may help in maintaining the psychological profile of Police Personnel. Psychologists in India are concerned mainly with the investigation of determinants of behavior and generally use psychometric tests for personality assessment. The psychodiagnosis is a major role of psychologists in western clinical settings. Apart from psycho diagnosis they administer psycho therapy and use projective tools as intervention technique (Sharma et al, 1975, Cassell, 1990, Cassell and Dubey, 2003, Dubey 1982). There are three standardized test based on inkblot technique: Rorschach, Holtzman and Somatic Inkblot Series (SIS). SIS is comparatively the recent inkblot test which has adopted latest technology of presentation through Video tapes and CD. The test was originally conceived in 1959 by Cassell. It is a structured, Projective, diagnostic procedure and is an adjunct to psychotherapy (Cassell and Dubey, 2003). The test is proved to be an effective instrument for personality assessment, diagnosis, screening and therapeutic intervention (Dubey, Dwivedi and Singh 1999). The best part of the test is reported “its Self Administration quality” which reduces test anxiety, as the tester is not present during the testing. It also saves time of the tester. The SIS has attracted researchers because of it’s simple administration and scoring procedures. The test S.N.Dubey,Ph.D.,Reader, Dept of psychology,K.S.Saket P.G.College,Ayodhya, Faizabad(India) B.L.Dubey, Ph.D., Director SIS Center, 1671, Sector-49B,PUSHPAC Society, Chandigarh-160047(India) Email:sisdubey@rediffmail.com Key Words : SIS on Polic Personnel.

has been used successfully in industry as “group administered test” for personality assessment. The SIS Card form was administered in a group of 10 Police Personnel to help them in managing their stress in the present study. SIS is a widely used inkblot technique in India. Singh et al, (2001) studied the profile of professional murderers and reported that SIS is a powerful psychological test to discriminate murders from normal population. In a study on militants, Saldanha (2002) found that the militant groups operating in the Kashmir valley were unlikely to benefit from rehabilitative measures and SIS is useful in understanding the psychology of militants. Basu and Nandy (2004) reported the profile of substance dependents and Kumar et al (2004) reported the profile of Schizophrenic and Manic patients. Emotional profile of epileptic adolescents has been studied by Sanyal and Banerjee (2004). Dubey, et al (2004) has studied the role of SIS in Psycho Sexual disorders and Ramjee Lal (2004) assessed the personality profile of physically disabled adolescents. Cassell (1991) reported the efficacy of SIS on an Alaskan Police Officer who witnessed an accident. Policeman is more likely to witness accidents exposing them to psychological trauma. The subject was a State Trooper, in a remote area, who responded to an accident scene. It involved a family of four whose car was struck head on by vehicles driven by a drunk driver. The patient policeman was administered SIS-Video. His responses revealed that he was also suffering from a form of Post-traumatic Stress Disorder. Image 2A activated repressed, painful memories of an event that had taken place 13 years before a terrible accident. The image reminded him of a badly injured father, trapped in the wreckage, desperately trying to reach a bleeding, screaming child, who had been thrown out at the time of a head-on collision. During the detailed inquiry, his defenses collapsed, and he wept. He vividly recalled the horrible details as follows: “when I close my eyes, I can smell the heat of the pavement, and blood. Blood has a special smell!” For the first time, he was able to express his emotional anguish as a cathartic, therapeutic experience. Immediately after this was expressed, his consciousness was flooded with an additional series of memories. These concerned scenes of injured and dying children that he had witnessed when he was working with native Alaskans. There is a high rate of alcoholism among the Alaskan natives. Accidents, homicides, suicides and other acts of violence are all too common. An example of one of his painful memories is as follows: “there was this little girl lying on the table-the kitchen table. She was small-just a little thing, and she was so quietshe wasn’t moving. I had to take her from the father. He didn’t want to let her go. I had to have an autopsy. Finally, I had to pull, and say “I’m sorry!, I’m sorry!” (Expressing profound guilt and sorrow).” In follow-up psychotherapy, he recalled a series of forgotten, emotionally charged dreams dealing with trauma to children. Eventually, he acquired insight into his own background. He realized that the abandonment that he had experienced as a child by his alcoholic father had made him especially vulnerable to such traumatic events. The SIS helped him in releasing the trauma after several therapeutic sessions. Cassell (2003) reported another police case. This case involves a 34 years old, highly intelligent man, who in his early twenties was a state trooper. While he was driving his police car alone in a very remote area, three men ambushed him. There was an extensive gun battle, during which he killed two of his attackers. However, he was wounded before back up was able to arrive and rescue him. While he was treated medically, he never had the opportunity for formal psychological treatment. 154 Dubey and Dubey

Eventually, his physical wounds healed and for medical reasons he retired. Ultimately, he went to a university for training in a new field. However, for many months following recovery, he had recurrent anxiety-laden dreams, reliving the gunfight and other symptoms of Post-traumatic Stress Disorder. Sometimes he had nightmares where he woke-up in terror with his heart pounding, but he could never recall the content of his most recent dreams. This is the example of how the SIS images represents a “time machine“ by taking him back to his original trauma. When he viewed the SIS Video, he projected responses consistent with his long-forgotten “nightmares” of the shooting incident. For example, he stated that 30A represented a highly threatening image. He visualized an X-ray of the head, re-experiencing images of the forgotten trauma. The second most threatening image was 15B. Here he saw “sharp thing that hurt”, replicating the bullets that had been fired through the windshield of his police car during the ambush years ago. The third most upsetting image was 3A. For this he saw “a blast-hole in a police car.” He stated, “I can see blood splattered on the window.” The processing of this repressed trauma represented the first step in resolving this old psychological injury. While it is better for victims of traumatic life events to process their emotional pain in the immediate hours after the trauma, there may still be powerful therapeutic value years later. The SIS images can do much to alleviate deeply imbedded and forgotten traumatic material. However, the review is scanty particularly on police personnel with SIS test. Objective: The present study is an attempt to find out the effect of psychological intervention with the help of SIS-I among Police Personals and help them in releasing their stress. Methodology: Sample: A sample of 50 Police personnel posted at a very important position in Ayodhya were taken for the study. They were consented about the test and those cooperated were included in the study. Material: Somatic Inkblot series (SIS-I 20 Cards set) GRS Biofeedback Machine Design and Procedure: The subjects were explained the purpose of the study and those interested were administer SIS on first and tenth day followed by Bio-feed back on second and tenth day. The therapeutics intervention continued for 8 days. Day I: Rapport was established and clarification of the study was given to participants. The SIS –I was administered in a small group of 10 subjects following standard instructions (Cassell, 1990, Cassell and Dubey,2003). Day II: Training on GSR Biofeedback machine was given to participants. They were trained to glow the maximums number of green bars through mental powers. During the training, subjects were told to repeat autogenic phrases: I feel quite, my hands are heavy and SIS on Polic Personnel

warm, my ankles, knees, the whole body is heavy and later on relaxed. More glows of green bars are an indication of relaxation. Day III: Progressive Muscular Relaxation (PMR), Shaw Asana and Onkar Meditation Day IV to IX: PMR, Shaw Asana, Onkar Mediation Day X: Testing with GSR Biofeedback and SIS-I Results and Discussion: To find our effect of Psychological intervention the responses of SIS-I images on First and Tenth day were compared. Through Cassell and Dubey (2003) have emphasized content analysis for the interpretation of responses, only quantitative analysis has been carried out in the present study. Critical Ration statistics has been used to find out the significance of difference between the responses of pre and post administration. The number of responses was counted in each of the scoring category. The mean, SD and Critical Ratio have been presented in table 1. The analysis of the data presented in Table 1 reveals that a significant difference have been found on six indices after the psychological intervention. No significant difference was noticed in total number of responses (CR=.42). It indicates that there is no change in imaginative capacity and intellectual functioning of these subjects. Human Responses (H) have increases significantly (CR=11.30) suggesting that the psychological intervention helps in improving interpersonal relationship with others. A significant increase (CR.38) in Most Typical Responses (MT) is indicative of coherent, logical thinking and ability to keep up with the demands of society. It also suggests the ability to make a group/team. It may further indicate that Psychological intervention helps in increasing ego strength and team concept in police personnel. There is a significant decrease (CR=0.55) In the Anatomical Responses (At) suggest that Police personals after psychological intervention could achieve better self-image and less preoccupation with internal body organs. It also indicate reduce anxiety and tension after therapeutic intervention. Since these inkblots are highly structured- in the absence of organic brain diseasefailure to respond to a particular blot can be quite revealing. It can be helpful to understand the viewer’s interpersonal interactions to observe the interaction of the human figures that are perceived in the inkblots (Lerner, 1991). The avoidance of human content may reflect a lack of interest or discomfort in relating to people. Difficulty in detecting the anatomical structure may suggest a detachment from body experiences and reduced awareness of emotionally cued body sensations. Individuals with a high somatic rejection index may manifest an inability to introspect. In regard to perceiving others they may lack empathy. The rejection of images in police personnel were slightly high than normal subjects (Cassell,1979: Cassell and Dubey,2003, Dubey and Cassell,1993,Mishra,1996). However, a significant decrease (CR=.27) in Rejection of Images has been noticed after psychological intervention suggesting that they are more open to accept the reality and ready to modify their behavior. 156 Dubey and Dubey

Table 1 Means, SD and Critical Ratio Showing the Significance of Difference between Means of Pre and Post Intervention on SIS-I Scores Indices Before Intervention After Intervention C R (N=50) (N=50) M S D M S D Total Responses (R) 24.58 3.56 25.62 3.64 1.42 Human Responses (H) 1.96 0.85 3.88 1.03 11.30** Animal Responses (A) 1.32 0.69 1.22 0.58 0.91 Anatomy Responses (At) 2.86 0.80 1.05 0.58 10.55** Sex Responses(Sex) 1.63 0.61 1.60 0.48 0.27 Movement Responses (MT) 1.30 0.82 1.52 0.78 1.37 Most Typical Responses (MT) 2.60 0.96 4.78 1.12 10.38** Typical Responses (T) 4.39 1.22 4.31 1.15 0.32 Atypical Responses (AT) 1.21 0.62 1.11 0.64 0.83 Rejections of Images (Rej) 2.12 1.10 1.35 0.75 4.27** Pathological Scales : Pathological Anatomy (PAS) 3.60 1.30 1.06 1.02 10.16** Depression (D) 1.54 0.60 1.38 0.96 1.00 Hostility and Aggression (HAS) 4.30 1.41 1.12 0.65 10.49** Paranoia (P) 1.41 0.72 1.30 0.70 0.73 ** Significant at .01 level, Other CR values are not significatn The responses on Pathological Anatomy Scale (PAS) have gone down significantly (CR=10.16) suggesting that after psychological intervention the police personnel showed a marked shift from deceased pathological anatomy to healthy body imagery. The responses on Hostility and Aggression Scale (HAS) has also shown significantly decreasing trend (CR=10.49) after psychological intervention. It suggests that the intervention program helped these subjects to reduce/control their hostility and aggression involving physical assault or body injury. It may be taken as an important indication which may help the police personnel to build up a genuine relationship with society. Normally people are afraid to have relationship with police. There has been slight decrease or increase in other category of responses suggesting no impact of psychological intervention on these indices in short time. The study with its limitation of being conducted on a small sample of 50 may suggest that a psychological intervention program along with SIS is necessary at regular interval to make the police force effective in the country. Conclusions : The present study was conducted on 50 police men. They were administered SIS test along with Progressive Muscular Relaxation (PMR), Shaw Asana and GSR Bio-feed back. The SIS was readministered 10 days after intervention program. The results suggest significant increase in Most Typical (MT) and Human responses (H) and decrease in Rejection of images (Rej), Atypical (AT) and Pathological (PAS and HAS) responses. The findings further indicate the effect of intervention thru Progressive Muscular Relaxation (PMR) and Shaw Asana. SIS on Polic Personnel

References: Ames, L.; Learned, J.; Metraux, R. and Walker, R. N. Rorschach Responses, New York, Hoeber 1954. Basu,J. and Nandi,R.(2004) Substance Dependence , General mental Health and Somatization Responses: A Study of ganja smokers, Tobacco smokers and Non Smokers, SIS Journal of Projective Psychology and Mental Health, 11:2,75-84. Cassell, W .A., Anatomical Rorschach Responses and Death Symbolism. British J. of Projective Technique and Personality Study, 1979, 24: 7-16 Cassell, W.A. (1980) Somatic inkblot Images (SIS-I) Somatic Inkblot Center, Anchorage, Alaska Cassell, W.A. (1990) Somatic inkblot Images (SIS-II) Somatic Inkblot Center, Anchorage, Alaska Cassell, W.A. (1991) Police Case:Witnessing an Accident, Japanese Bull. Arts Therapy,22,1-8. Cassell, W.A. (2003) Assault on Policeman, SIS Journal of Projective Psychology and Mental Health, 10, 93-96. Cassell, W.A. (1995) Somatic inkblot Images (SIS-II) Somatic Inkblot Center, Anchorage, Alaska Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World Through Somatic Imagery: Manual of the Somatic Inkblot Series. Somatic Inkblot Center, Anchorage, Alaska. Dubey, B.L. (1978) Rorschach Indicators in Normal and Clinical Groups in Military Population, PH.D.Thesis, Panjab University, Chandigarh. Dubey, B.L. (1982) A Pragmatic View of Rorscheach Inkblot Technique. National Psychological Corporation. Agra. Dubey, B.L. and Cassell, W. A., Some Experiences with Somatic Inkblot Series- II. British Journal of Projective Psychology, 1993. 38, 1: 19-41. Dubey B.L., Dwivedi, P. and Singh M.P. (1999) The Application of Somatic Inkblot Series. Workshop Presented during National Seminar on Health Psychology, K.S. Saket P.G. College, Ayodhya, November, 28-30. Dubey, B.L., Ajith, C., Gupta, S. and Kumar, B. (2004) Role of Somatic Inkblot Series in Psycho Sexual Disorders in India. SIS J. Proj. Psychology and Mental Health, 11(2), 115-120. Kumar, S., Singh, R and Mohanty, S. (2004) Comparative Study of SIS-I Indices between Schizophrenic and Manic Patients, SIS J. Proj. Psy. and Mental Health, 11(2), 115-120. Lerner, Paul Psychoanalytic Theory and The Rorschach. The Analytic press, Hillsdale New Jersey. 1991 Mishra, M., Compatibility of SIS-II and the Rorschach Indices in Normal, Neurotics and Schizophrenics,. Ph.D. Thesis , Banaras Hindu University, Varanasi, 1996 Ramjee Lal (2004) SIS with Physically Disabled Adolescents. SIS Journal f Projective Psychology and Mental Health, 11 (2), 121-123. Saldanha, D. (2002) Profile of Militants: An Attempt to Study the Mind of Militants. SIS Journal of Projective Psychology and Mental Health, 9, (1), 23-32. Sharma, V.P., Ojha, K.N. and Vagrecha, Y.S. (1975) Clinical Psychology in India, Indian Journal of Clinical Psychology, 2, 73-76. Sanyal, N. and Banerjee, P. (2004) Emotional Profile in the Context of Depression, Anxiety, Aggression and Adjustment of Epileptic and Non-Epileptic Adolescent: A Comparative Study. SIS Journal of Projective Psychology and Mental Health, 11 (2), 105-114. Singh, A.R. Manjhi, K.C., Dubey, B.L. and Banerjee, K.R. (2001) SIS-II Profile of Professional Murders. SIS Journal of Projective Psychology and Mental Health, 8, (1), 28-30. 158 Dubey and Dubey

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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

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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, # 1671, Sector49-B, PUSHPAC Society, Chandigarh 160047 Ph.: 91-172-2634150 Mob.: 91-94170-36655, E-mail: sisdubey@rediffmail.com : Anil Agrawal, BE, MBA, Exe. Director, Meta Strips Ltd., Upasana Nagar, P.O. Zuari Nagar, Goa-403726 Ph.: 91-9823034664 E-mail : anil.agrawal@metastrips.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 : Nalini Mishra, Ph.D., Plot No. 196, Saket Nagar, Naria, Varanasi- 221005, Mob.: 91-9415814458 E-mail.:sisdubey@rediffmail.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 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, Ph.D., India K.V. Kaliappan, Ph.D., India Arvind Keshary, Ph.D, India Bhushan Kumar,M.D.,India Anatoly B. Khromov, Russia R. Kumar, Ph.D. India Sudhir Kumar, M.D. India Lisa Milne, Ph.D, Australia Mridula Mishra, Ph.D., India EDITORIAL CONSULTANTS 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 Yasho V. Verma, Ph.D., India