SIS Journal of Projective Psychology & Mental Health

JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 13 Number 2 July, 2006 SIS ISSN 0971 - 6610 Vol. 13, No. 2, Pgs. 83-161 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH 2006

SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH is a refereed journal and published twice a year (January, July) by the SOMATIC INKBLOT SOCIETY and is devoted to the advancement of research in the areas of projective psychology, personality assessment, psychotherapy and mental health. The journal is broadly concerned with the development of inkblot tests and personality assessment in clinical, counseling, cross-cultural, organizational and health psychology settings. It aims to reach clinical psychologists, psychotherapists, psychiatrists, social workers, medical professionals and professional managers interested in the understanding and modification of human behaviour. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences etc. and letters to the editor. MANUSCRIPTS PREPARATION: Manuscripts should be typewritten (doublespaced throughout) submitted through E-mail or in CD to B.L. Dubey, Ph.D. Editor Emeritus, SIS Journal, E-mail:sisdubey@rediffmail.com. or sisdubey@yahoo.com with a copy to Amool Ranjan Singh, Ph.D. Editor In Chief and Head of Clinical Psychology,RINPAS,Kanke,Ranchi-834006. E-mail:editor_sis@rediffmail.com Mob 91-9431592734.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/ SIS Journal of Projective Psychology & Mental Health. 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. Indian institutional life membership is Rs. 4000/-. 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 Amool Ranjan Singh, Ph.D. Editor In Chief. Members in foreign countries should send the cheque to B.L. Dubey, Ph.D. Editor Emeritus, 4406 Forest Road, Anchorage, AK-99517 (USA) 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 Copyright @ 1994. SOMATIC INKBLOT CENTER, India/Anchorage U.S.A. Website: http://www.somaticinkblots.com

SIS Journal of Projective Psychology & Mental Health Volume 13, Number 2, July 2006 Contents Page Nos. 1. Editorial : Somatic Inkblot Series: Assessment 83-84 and Therapeutic Tool, B. L. Dubey 2. Tracing the Roots of Violence by associating Dream 85-106 and SIS Images: A Vicarious Visit to an Adolescent’s Birthday Party, Wilfred A. Cassell and B.L.Dubey 3. Impulsivity in Eating Disorders: Analysed Through 107-119 Wartegg Test, Silvia Daini, Carlo Lai, Giuseppe Manuel Festa, Francesca Maiorino, Massimiliano Pertosa and Sergio De Risio 4. SIS-I and Rorschach in Schizophrenia: A Correlational 120-124 Study, S.Kumar, R.Singh, S.Mohanty and R.Kumar 5. Psychoanalytic Conceptions of the Mind in Relation to 125-138 Personality Disorders of Drug Abusers, Kristian Aleman 6. Personality Assessment of A Child With Emotional Problems 139-146 A Case Study, Nilanjana Sanyal, Manisha Dasgupta, Danae Marinakis and Olga Doukas 7. Novelty and Meaning Contexts of Creativity vis-a-vis 147-160 Jensen’s Level I and level II Abilities, Umed Singh 8. Address of New Editor in Chief

SIS Research Award The editors and editorial consultants wish to express their sincere appreciation to Dr B.L.Dubey for his insightful and dedicated leadership. We wish to announce his selection for this year’s Research Award of one thousand dollars. Also to be praised are the behind the scenes supportive efforts of his wife Padma Dwivedi. Under their loving guidance, we have witnessed the birth of a new body-mind-spirit journal for SIS workers internationally. We also wish to acknowledge the impressive contributions of their son Anand Dubey. He has elevated the journal beyond traditional paper bound words to an electronic state of the art Internet communication vehicle. We anticipate many further years of their dedication to spreading information about the power of SIS technology for assessment and healing. Wilfred A. Cassell, M.D., FAPA. Director SIS Center Editor emeritus, SIS Journal of Projective Psychology and Mental Health, 2020 Muldoon Rd, #317,Anchorage, Ak.99504 (USA) Email: siscassell@yahoo.com

Editorial Somatic Inkblot Series: Assessment and Therapeutic Tool After 14 memorable years serving you as Editor in chief of the SIS Journal of Projective Psychology and Mental Health, I wish to take this opportunity to sincerely thank all members of the Editorial Board, from 1994 to the present, for their continuous support during the journal’s birth phase. I wish to highlight the contribution of Dr Wilfred A. Cassell for his excellent thought provoking papers almost in every issue, without which our endeavor would not have so widely recognized. Since its introduction, it has been regularly published bi-annually in January and July. We anticipate as interest in this publication grows internationally, that it will be eventually published monthly. As it has gradually gained acceptance, the Professional membership has risen to over 270 and the Institutional Membership to 40. It has met the publication standards of the American Psychological Association and is abstracted in “Psychological Abstracts”. We are fortunate to have Professor Amool R. Singh, Ph.D., Head Department of Clinical Psychology, Ranchi Institute of Neuro-psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi to serve as the new Editor-in-chief. Over the past twenty years, I have had the privilege of knowing him personally in many roles: as a student, a practitioner, clinician, researcher and now professor at one of the two leading psychiatric institutions in India. While I leave my present editorial position with sadness in my heart, I am extremely pleased with the Editorial board’s awarding the future leadership role to him. He is an excellent academician and fine man. It affords me great pleasure to welcome him and his wife Archana Singh, who has played an important role in his professional success. I am very excited about the future of our journal. In addition, it also gives me great confidence for our journal’s scientific prestige to welcome Col. Professor Suprakash Chaudhury, M.D., Ph.D., Head Dept of Psychiatry, at RINPAS, Ranchi and editor of the SIS journal. I also welcome the many faculty members and students at RINPAS, Ranchi who are devoted to the journal’s continued success. Consistent with the early international interest the original Manual for the SIS-I has been translated for publication in Italian and Russian. More recently Dr Cassell and I published a Manual for the SIS-II Video (Cassell and Dubey, 2003). This included normative data on different populations such as students, business executives and army personnel. Norms are also available as guidelines for assessing clinical cases. The latter visual stimulus presentation system now is available for a computer monitor presentation format. Much further work needs to be done in standardizing these procedures as well as scientifically evaluating their multiple assessment and treatment applications. Early on in clinical situations it was first observed that the various applications of the SIS provided a unique opportunity to examine subjective percepts related to the human body. These enable the examination of previously illusive concepts related to health and sexuality as well as physical symptoms. Moreover, the projective technology has the capability of triggering the release of short term, intermediate and long-term visual memories. The validity of this became SIS J. Proj. Pst. & Ment Health (2006) 13 : 83-84

established in clinical situations involving severe psychological stress. Through direct and symbolic content analysis, the trained SIS clinician can reprocess these with cognitive psychotherapy for optimal outcome. In further introducing applications of the SIS to established professionals, I anticipate further resistances in their general adoption. One area that seems to have been particularly troublesome for those grounded in physical scientific facts, involves the spiritual healing applications. Traditionally there has been a wide gap in the thinking of those with a scientific orientation to body-mind processes. Yet for many of us, religious principles provide fundamental compass directions for civilized life. Unfortunately, in the world scene, historically and in the present, religious rationalizations have provided a sick basis for heinous crimes and aggression. It has been repeatedly observed in clinical situations (but not based in scientifically based statistical studies) that the SIS can sometimes serve as a “Spiritual dream catcher”. Individuals grieving the death of a loved one, when shown the SIS at bedtime, often experience contact dreams. Through the physical medium of the SIS stimulus, either paper or electronic, the dreamer is able to visualize and emotionally experience healing emotions from the deceased person’s spirituality. “Since projective tests in general and somatic inkblot images in particular are not based on verbal communication, they have power to penetrate the “outer shell” of defenses and surface behavior. They use the language of dreams, visual imagery and symbolic thought, the most basic forms of thinking and expression. The SIS images takes you back in time when you start processing the unconscious material. The SIS document then works as an aide to this journey. The symbolic and content analysis of the responses helps in hearing the inner cry of the suffering individuals and planning for the therapeutic aid (Cassell and Dubey, 2003)”. Dr.Cassell deserves our congratulations for this innovative contribution to the humanity. I sincerely approach you to actively support this noble venture. Please continue to send research papers and clinical studies. I also appeal to you to help us expand our professional and institutional membership. We also deeply appreciate all forms of financial support to our non-profit SIS Society and this international journal. Reference: Cassell,W.A. and Dubey B.L.(2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot series, SIS Center, Anchorage,Alaska Bankey L. Dubey,Ph.D. Professor of Psychology Editor emeritus, SIS Journal of Projective Psychology and Mental Health, 4406, Forest Road, Anchorage, AK 99517(USA) Email: sisdubey@rediffmail.com 84 Dubey

Tracing the Roots of Violence by associating Dream and SIS Images: A Vicarious Visit to an Adolescent’s Birthday Party Wilfred A. Cassell and B.L.Dubey The Somatic Inkblot Video was administered to two cases: The first study examines the case history of a severely traumatized seventeen 17 years girl whose homicidal behavior led to psychiatric hospitalization. The second case was a fourteen-year-old Black youth with history of violent behavior. The Somatic images were able to bring out aggressive imagery and relevant unprocessed repressed material helpful during therapeutic intervention. The interview with patients and significance of somatic images are discussed in the paper. “ I’m turning seventeen today. I drink blood, collect skulls and worship Satan. I came to the hospital because I almost killed my aunt and uncle. During the night, somehow I got up. I went into the kitchen…I got a knife and went into their bedroom and was standing over them with a knife ready to kill them…and then something clicked and I realized that I was there…I don’t remember how I got there…but if my mind wouldn’t have clicked just then I would have killed them” Surely the scene of a murderous teenage girl hovering with a knife over her sleeping relatives evokes disquieting emotions. Any professional dealing with violence prone adolescents these days in America has valid cause for concern. In any case, thank you for beginning to read this case history study. You will be given a powerful projective opportunity to view her homicidal dream/SIS image linked associations. Please be warned in advance, that the clinical material to be presented may be potentially stressful. If you choose to continue, be prepared to open your heart and mind to the evils of satanic cults, as well as paternal abandonment. The risk may be worthwhile. Perhaps tracing the origins of violence in this in-depth manner may illuminate otherwise undetectable basic psychobiological processes. In order to empathetically enter the tormented inner world of the above-introduced girl suffering from stress induced Dissociative Amnesia; please actively conjure up your own visions of her aggressive imagery. These will be presented for your inspection in a “poem”, dreams and responses to the SIS-II Video. The video first induces a state of hypnotic like relaxation with the presentation of pictures of 62 flowers followed by the same number of structured “Inkblots” (Cassell and Dubey 1998, 2003). The viewer is instructed by the audio to record responses on an answer sheet. Like in dreams the responder is alone. This tends to reduce inhibitory influences that might be expected from the examiner’s immediate presence. The technique can release long forgotten traumatic memories for analysis and psychotherapeutic processing (Cassell, 1991, Cassell, 1997). In this conceptual model, what is projected represents a sort of mental “Inkblot” for the examiner as well. Consider what happens inside your brain, as a detached professional, when you envision violent affect charged SIS responses. Cognitively you will have the Wilfred A. Cassell M.D., FAPA, APC Editor Emeritus, SIS Center, 2020 Muldoon Rd, #317,Anchorage, Ak.99504 (USA) E-mail: siscassell@yahoo.com and Bankey L. Dubey,Ph.D.,Professor of Psychology, 4406, Forest Road, Anchorage, AK 99517(USA) Email: sisdubey@rediffmail.com Key Word : SIS Imagery and Dream SIS J. Proj. Pst. & Ment Health (2006) 13 : 85-106

task of identifying the embedded SIS color-form-movement structure. Concomitantly, you will be subjectively experiencing emotions from reading the word pictures describing any posttraumatic “Nightmares” and visual hallucinations released from the subject’s neural memory storage system. If you have used the SIS, you do this against your previously created brain screen. This inner standard was previously generated from a composite of your own original visual impressions, your memories of what people you have examined have visualized, and your recall of published SIS norms. It has a psycho physiological foundation in the somatic sensations associated with your past emotional responses to specific SIS color-form-movement. Consider contaminating your own inner visual memory neural centers by the evil imagery reported by this Devil worshipping violent girl. If this seems too threatening, depending upon your professional orientation your choices may be restricted. Perhaps you are a psychologist and determined to use “Inkblot” projective tests. If so, consider only psychometric scoring systems that avoid symbolic content analysis. Better still; restrict your psychometrics to emotionally sanitized non-projective tests. Their statistical norms necessarily introduce levels of conceptual abstraction involving group identification and diagnostic nomenclature. Their quasi-scientific connotations will assist in the building of empathetically impervious barriers so you do not have to identify with the suffering of one particular soul. If you are a modern psychiatrist lacking training in depth psychology and psychotherapeutic techniques, it might be wise to continue restricting your field of expertise to boundary safe psychopharmacology. All other professionals should continue reading, only if you consider yourself to be well grounded in positive spirituality and self esteem. The effort could prove of particular value in providing new avenues of clinical investigation, especially if you have skill in the psychotherapeutic use of imagery. However, you must be prepared to accept the boundary rule for professionals treating adolescents: “No empathetic pain, No gain!” This phenomenological study first examines the case history of a severely traumatized girl whose homicidal behavior led to psychiatric hospitalization. One important aspect of her psychotherapy involved the group examination of the symbolic imagery in her “Poems”, dreams and SIS-II video responses. To document this clinically useful image association linkage, a training video was made. This was recorded on her seventeenth birthday, just prior to her transfer to a long-term adolescent treatment facility. It expands upon earlier studies using the SIS to clinically investigate the significance of aggressive imagery (Cassell, 1977, 1980, Cassell and Dubey,1998, Cassell, et al 2002). In order to facilitate communication, a fourteen-year-old previously violent Black youth from her therapeutic group was concurrently interviewed. Adolescents will reveal in the presence of peers they trust, personal imagery, that otherwise would be concealed. To reduce the bonded pair’s stage anxiety in front of television cameras, the setting included a table with a birthday cake, as well as a friendly female Black lab. In addition, they knew that as an additional support, their psychiatric nurse was nearby watching off stage. After they left, her observations to their interview were videotaped. Now imagine that you are comfortably sitting beside the psychiatric nurse in the background watching the “Birthday Party” interview. Please attempt to conjure up the imagery reported by the adolescents while empathizing with their emotions. 86 Cassell & Dubey

Dr C.: B. could you just say how you feel today, as compared to when you first came in a while ago? (Addressing the girl.) B: I feel a lot happier. Dr. C.: It is sure nice to see that! Tell us a little bit about what brought you in and all that please? B: Well drug use and alcohol abuse…anger problems and suicidal and homicidal tendencies. Dr C.: Okay. B. How about you J., what brought you in? J: Drug and alcohol abuse…family problems…school problems…inhalant abuse…I have a problem accepting authority…bad temper. Dr. C.: I know that you had each had written a “Poem”. One B. captured some of your own feelings about some of the conflicts that you had that led to your problems. Could you please read it? (Requesting them to read their “Poems” provides structure serving as a communication catalyst. Reading their emotionally charged word pictures has been found to activate dormant memories of past stressful past life situations and posttraumatic dreams. Immediate review can result in more powerful projection of stress specific symbolic SIS images.) B: This is a “poem” that was written at the hospital: “My father needs to die but going to Hell is too good for him. I want him to feel pain. He needs to hurt. I want to hurt him. I want to plant his face in the dirt. I want him to spill his guts, literally so that I can laugh in his face. He doesn’t deserve to die. It would be too easy for him. He needs torture. He needs help. He is worse off than me, and look at where I am. He was an asshole and a prick. I want to kill him. I want his head on a stick. He has power that he doesn’t deserve. Just because of the power he has the nerve to turn my life upside down.” Dr C.: Can you tell us a little bit about how that captures your feelings about your father. B: Because my father is one of the main reasons why I have anger. Dr. C.: From what you told us, you were a victim of sexual abuse. B: Yes. This is my stepfather, not my real dad. Dr C.: Yes that is right. And you were having some dreams reflecting some of the feelings you had towards him? B: Yes, I was having dreams like, where me and all my friends, or just me, we were tying him up and laughing at him. We would mutilate him and just hurt him in any way that I could even think of. Dr C.: And you had tremendous feelings of rage? B: Yes. Dream and SIS Images 87

Dr C.: Okay. Thank you. Now can you read your “poem”, please J.? J: Love is mess. It is anything. I wonder if it is a real emotion or something imagined. Sometimes I wonder why love is such a good thing when the only thing I see it doing is bringing heart ache and pain. I know for a while that it really feels good, but eventually it hurts, no matter what you do, no matter what you say. I know that I am hurting every single day. I am torn apart and I don’t know if I have the heart. It has been stomped and kicked and everything else. Sometimes I feel like it is gone. Like it is nothing. Then comes the emotions and I know that I am wrong. All I see is it is a game, and not the pain. I hate that. I want to love and be loved back. I want to be happy and I deserve that.” Dr. C.: Thank you J. How does that relate to some of the problems that you had that brought you into the hospital? J: Well my drug and alcohol problem would make me more sensitive to things people would say. And I already had a bad attitude and problems accepting discipline. So when I would drink, or get stoned, I would do stuff to people I love. Dr. C. Previously in group psychotherapy, you mentioned that you had guilt and that would bother you? J: Yes. Whether it was a parent, my uncle, or my girlfriend, the drugs bringing out my emotions and my attitude. So I would say things or do things that I would regret. SIS Interviews: Dr. C.: Okay. At this point, maybe we can look at some of the responses to the SIS video. I would like to look at the three responses that each of you felt as your favorite ones. (Starting with ones with positive affect provided an emotionally safe opening for the joint SIS interview.) For you B., B5 was your favorite and you said “Because I think sharing thoughts is cool.” And do you remember what you saw when you looked at b5? B: Oh. It is two people, silhouettes of people sitting in chairs and there is three circles going between them. It reminded me of people having the same thoughts and sharing them without using words…just brain waves. Dr C.: And how does that relate to maybe what you learned in the hospital as far as the value of communicating and sharing. Do you remember when you came in you were sort of walled off to people. B: I learned that there are other ways to express yourself. There are many ways. Dr C.: And it is okay to trust. B: Some people yes. Dr C.: Some people. Dr C.: And then you saw 28B as your second favorite. Could you comment on what you see there please? 88 Cassell & Dubey

B: A woman holding her child. I think that is a pretty picture because it symbolizes love. Dr C.: Yes. Okay. And the third favorite was 30A. Can you say what you see there please? B: Oh, a really cool looking skull. The skull sees nothing but knows all. (This clearly has grandiose connotations. Victims of satanic cults are sufficiently “brain washed” to believe that their cult leaders are omnipotent. Through a mind-spirit altering manipulation involving magical religious ritual, trance inducing dances and sexual orgies, this evil power is then symbolically transferred to the victims through skulls.)… I collect skulls. Dr C.: Could you share about collecting skulls, what that is all about? B: I used to have a lot of clothes with skulls on them and I used to draw them. I have jewelry that has skulls and stuff. I collect them. Dr C.: And have you seen skulls, real skulls? B: Yes, I have seen lots of them. Dr. C.: You can talk about some of your experiences. B: Well some in museums. I have seen them with friends that I was hanging out with. They would have some. Dr. C.: And that was something of a cult activity was it? B: Yes. Dr. C.: Could you share about that please? B: Well I belonged to a cult in Arizona… well I used to when I lived there…and they have them from past sacrifices. Dr. C.: Okay. And the sacrifices would involve what B.? B: Sacrificing to the Devil? Dr. C.: And you previously said that it would involve episodes of killing animals and drinking blood and those sorts of things? B: Yes, killing animals, and drinking the body fluids from those animals. Dr. C.: And you would worship Satan? B: Yes. Dr .C.: What impact did all that have on you, do you think? B: At the time I was doing it, it was making me happy. Dr. C.: Okay, and then subsequently, when thinking about it? B: Do you mean now? Dr. C.: Yes. B: Now, I would still do that now. Dr. C.: Why is that? Dream and SIS Images 89

B: Because I enjoy it... that is who I worship. J’s SIS Interview: Dr. C.: J, let’s look at the ones that you found interesting, okay? A10 was your favorite and can you tell us what you see with A10, please? J: Things you see when you are on rubber cement… Glue… Things that I saw when we were in the car and parked, and I would sit there and I would space out and look at my friends and that is what I would see. That is exactly what I would see. Dr C.: And when you saw the images, how would you feel? What was the emotion? J: I just thought this was cool because I could hear voices, but that wasn’t what I saw. So I would do more…longer Dr C.: And what is your attitude to that now. You have been in therapy for a while? J: Well the reason why I saw those was because it was really messing up my brain. That is what the high was. It was destroying my brain. Dr C.: And that is something that you want to avoid now? J: Yes…very much! Dr C.: Okay. And can you tell us how you first got involved in drugs and all that? J: I first started when I was little, when I was about in eighth grade. I used to play football. I still do, but it was when I first started. I was one of the best on the team. There was about four of us and we won tickets to the T. Bowl. So we went out there and our coach said that we did a good job and he stopped the car and parked it at this hotel and he gave us each a gram of marijuana. I thought I could get away with not smoking it, because I didn’t know what was going on. So after the game, he told me to come with him. So I went with him up to this hotel room and he smoked me out. That is how I first started? Dr C.: How do you feel towards the coach who would actually get you into using drugs like that? J: Now? Dr .C.: Yes. J: Well he has caused me a lot of problems now. It is that day I really got started. Dr C.: That is unfortunate. And your second image was 6A. What did you like about that? J: It is a little boy, he is happy and he has got a new bear. You can see a little smile on him, his feet and his hands are in the air. There is cute little teddy bear. Dr, C.: And what does that remind you of. J: Just being little and you can’t wait until you get bigger, get older. You wish you were little again, and had no problems. Dr C.: Was life fun and happy when you were a little kid? J: No. 90 Cassell & Dubey

Dr. C.: Maybe you wish it was a little better than. Then 14B was your third favorite? What do you see with 14B, please? J: It just reminded me of myself when I was in love and then hating it because I had a broken heart. It was love, but it was broken. Dr. C.: So how does that relate to the “poem” and your life experience with love? J: Well I was with this girl (His “Baby Momma”). I loved her very much only I didn’t know it. I would use and I would go to her, I’d be violent, I would yell. I would take her money to get high. And she would stand by me. But then we broke up and I was coming up here… and I figured out how much I really did love her, but it was too late. Dr. C.: So you have some sadness and regret. J: Lots! Review of B’s Threatening SIS Stimuli: Dr. C.: Okay. Thank you; now let’s do the ones that bothered you most. 19B bothered you most B and you wrote on the answer form “Because a broken world makes me feel sad.” Can you tell us what you see in 19B there please? B: It looks a globe and it is full of cracks. And then it looks like tentacles or something coming out from the world. I said it looks like a stamp because it looks a picture that would be on a stamp. And I wrote it looks like world where all love has been broken and the arms are reaching out to help. It makes me sad because the world broke apart; there is no love in it. Dr C.: How does that relate to what happened to you when you were little do you think? B: Because when I was little, I was confused about love. Dr C.: In what way were you confused about love? B: Because one of the men in my life that was supposed to love was hurting me. Dr C.: It was very tragic. Okay, 29B was the one that bothered you next in order and you said that it bothered you because you are scared of light. I wonder if you could tell us what you saw in 29B please. B: It is a man, it looks like he is running through a doorway and the doorway is full of light. And you wrote “Scary man running from the light because it scares him.” B: I wrote that because there is nothing behind him that you can see, and it looks like he is running from the light. Dr. C.: And how does that relate to your life experience? B: Because I like darkness. I like darkness. I like it to be dark. Dr. C.: And what is it about darkness that you like as compared to light? B: The fact that you don’t know what is out there. You have to feel your way. You can’t always see everything. You get to know something better if you don’t see it, I think. Because appearances I think is too much. People look too much at appearances. Dream and SIS Images 91

Dr. C.: And then finally 31B bothered you, can you share what bothered you about that. B: Oh… four people holding hands. They have big Afros and they are sad. It looks like a family and they are all holding hands. It makes me so sad to see that the whole family is sad. Dr. C.: Okay and what does that bring to mind for you? B: Well because after the time that my mom and my step-father got a divorce everybody in our family was sad. Dr C.: Thank you. Review of J’s Threatening SIS Imagery: Dr. C.: J. you found 15B as the one that bothered you most. What do you see there, and why did that bother you the most? J: 15B is a thing, and there is a bunch of knives being thrown at it. He has to do what they say. So I put that down as the hospital that I am in...You have to follow the rules. You have to do it or you are going to get cut. Dr C.: How do you mean cut? J: You will be here longer. Dr C.: I see. Have knives been an issue in your life? J: What do you mean? Dr. C.: Have has anybody threatened you with knives. When you have been angry have you threatened other people with knives? J: I have gotten into fights and pulled knives out. I have never been attacked with a knife before though. I did usually carry one around with me. Dr C.: Maybe we will come to B. and B.’s response to 15B too. Can you share that, what you saw there please? B: It looks like a bunch of blades being thrown into the fire so they can be molded into sharper ones. Dr. C.: and what does that remind you of? B: It makes me think…I like knives… I like the feel of them and everything. And fire you know, that is how you make swords. Pound them until they are red and stuff. And that is what it looks like because in the video it was red where they were being thrown into so they can be sharper because a dull knife is useless. Dr. C.: With the cult activity were you involved in any of the cutting of the animals, or anything? B: Yes. Dr. C.: Could you tell us about that? B: Well you slit the throat and then you let it drain into the bowl and depending on who is running it, they will say the words over the blood and everybody drinks it. 92 Cassell & Dubey

Dr. C.: Could you please share the episode that you had with the knife before you came into the hospital? B: What episode was that one? (Her brain’s visual memory system inhibited the affect charged murderous bedroom scene. She had to be prompted with the following question: “Remember you were standing over your relatives?” B: Oh, yes. I was angry at my aunt and uncle that is who I was staying with. And during the night, somehow I got up. I went into the kitchen. I got a knife and I went into my aunt and uncles room and was standing over them with a knife ready to kill them. And then something clicked. And I realized I was there. And I don’t remember how I got there. But if my mind wouldn’t have clicked just then, I would have killed them. Dr. C.: OK Inability for J. to recognize Male Human SIS Content: Dr. C.: Moving on to J., you saw 4A as one that bothered you and said, “I felt sort of stupid” and I guess you didn’t see anything there? J: Yes. It was nothing. It was a waste of time. Waste of film. I stared at it. I put it on pause, rewound it, and stared at it. It was nothing, it was stupid. I literally hated it. Dr C.: So something about that really brought out some anger. And B. can you tell him what you saw in that one pleases? B: I saw an abstract man with a big nose, and one eye open and one eye closed with a tear. Dr. C.: So what do you think your responses means, B? B: That is just the first thing that I saw when I looked at it. Dr. C.: (Speaking to J. who was turning the SIS answer sheet in puzzlement regarding his inability to visualize adult male facial SIS structure like B. did.) Dr. C.: No turn it this way. (J. still failed to recognize the symbolic structure.) Dr. C.: B., What does it mean though? The man like that with the tear. B: I don’t know. Probably because there is still a lot of sadness in me. Dr. C.: Yes. What is that sadness like at this time? B: Well it is not as strong a feeling as it was when I first came in here. I have tried to deal with a lot of it since I have been in here. Dr. C.: We appreciate that, but you are also feeling sadness about having to leave the hospital. (Previously reported to staff.) B: Yes, I have become close with a lot of people. Dr. C.: That is wonderful that you have, but what sense of sadness do you have in having to leave? B: Sadness, because when you are in here, when you are in the hospital, you are protected. They will feed you. You can’t get stoned. You can’t get drunk. You are protected. You go out there and it is like everything is right at your finger tips and you have to make a decision about whether to use it. It is kind of sad because sometimes I wonder if I am strong enough to not use it. Dream and SIS Images 93

Dr. C.: It is scary and we will talk about that more at a later time. Now J., you have seen and heard what B. said, you still don’t see anything? J: I don’t see anything. I don’t understand how she gets the big nose, one eye open. B: (Pointing to 4A) That is the big nose right there. That is the open eye. That is the eye that is closed and there is teardrop right there. You can see that in the video. J: I don’t see anything. I don’t see it Dr. C.: J., how do you feel about men and father figures? That is sort of an image of a man’s face. J: Well my father was never there when I was little, really. Dr. C.: Did that bother you? J: I was used to it. I thought everybody was like that. My uncle took the figure about two years ago when I moved in with him. Dr. C.: Yes, prior to your uncle’s involvement, did you feel sort of empty without a dad? J: I felt I had to do the job that he was supposed to do. Dr. C.: Okay. Let’s look at 31B and it was one that bothered you as well? J: It was pretty much the same thing as with B. It is a family. I saw family holding hands only I thought it was fake love, turned into a family. It is nothing. I used to think at night in my room at the hospital that I know that she doesn’t want to be with me right now, but she will come around, but I thought that was fake love because if she doesn’t love me, but she is only doing it not to hurt me, then it is useless. We would be empty our whole life and it wouldn’t be the same. If I’m happy and she is sad, it makes me sad. Dr. C.: Okay. Well in that B. is going to be leaving, we may spend a little bit more time with some of her responses, before we get Sharon, our psychiatric nurse. Some of the ones that we might look at a little bit. 1A, can you tell us what you saw there, please? B: It looks like a monster, with big eyes, and big fangs with sharp teeth… and two people coming out of the there crying. Dr. C.: Okay, and what does that bring to mind? B: Dreams that I had. Dr. C.: Tell us about those dreams please? B: I have really disturbing dreams about monsters. They would take my soul and I would become part of them. And my face and my body becomes part of theirs, and you can actually see it. I actually become part of their form. Dr C.: How do you feel when you image fuses with that of a monster? B: Sometimes it bothers me and sometimes I just accept it. It is just a dream. Sometimes it bothers me, depending on how intense the dream was. 94 Cassell & Dubey

Dr. C.: In what way does it bother you if it is really intense? B: Because it seems so real? Dr. C.: What does the dream symbolize? B: Probably that when I sold my soul to Satan, I became part of him. Dr. C.: How does that reflect your behavior at times? B: Sometimes I do things to make Satan happy? Dr. C.: Such as? B: Such as the sacrifices. Dr. C.: Could you tell us a little bit about some of those amnesic episodes that you had that we talked about the other day ... the blackouts? B: I will be sitting by myself, or where I would be walking. It never happens when I am talking. It is usually when I’m by myself and I’m quiet or still and I’ll see little flashes of light and then my mind will just go blank and I will forget who I am and where I am at.(Her neurological workup with EEG etc was unremarkable.) Dr. C.: That is scary. B: And who everybody else. I freaked J. out the other night. I was sitting there having a blackout and he asked me “are you okay, are you okay” and I just looked at him. I didn’t know who he was. Dr. C.: Can you tell us what happened that night when she blacked out J. please? J: She was watching a movie, or she wasn’t watching it. We were all watching it. And she just looked really dead. She was just like this. She didn’t move at all. So I said, “B. are you okay.” Dr. C.: Spooky? J: Yes, “What is wrong B.” And he just looked up at me and smiled. She just stared at me. And I’m like “Okay, what is going on.” Then she goes “I’m sorry and she gets up and walks away.” Goes and gets a snack and comes back. Then she goes “I’m sorry.” And I had already figured what happened because she told me about it, including when she had it before, so I figured that is what happened. I was just worrying that she was okay. Dr. C.: Well B. you are going to need a little more work before those go away. 2A if you could please? B: It looks like a man trying to get away from pain, anger and fright, and they finally pin him down. It looks like a man, see him right there. And his head is right there and his arm is reaching up and legs are going out. In the video it all looks like, when you have to draw your emotions. That is what it looks like. It looks like they have all just landed on top of him. You can’t escape them. Dr. C.: And how does that relate to you? B: Because what I hold my emotions in for long and finally I explode. And after you explode your problems are still there. Dr. C.: When you explode, what comes out, what emotions? Dream and SIS Images 95

B: Anger usually. Usually all my feelings are turned into anger. Dr. C.: Some of the episodes with your “Blackouts” you are actually blocking some of those strong emotions that you feel. Eventually as you work those emotional issues out, your mind won’t have to put up roadblocks. For 10A, what do you see there? B: A woman looking into a mirror and it is blurry because she is having a hangover. Dr. C.: How does that relate to you? B: Because I have looked into the mirror and seen that same picture before. Dr. C.: How about when you were sniffing gas what was that like? B: It was great. Dr. C.: In what way? B: In the way. In that I felt great. Everything was wonderful. Dr. C.: So you forgot your pain at the time? B: Yes. I wasn’t feeling anything except happiness when I was doing that. Dr. C.: Right. So hopefully you cannot have a need to block out so much pain and you won’t do it with gas. What does that do to your brain? B: It melts, it eats your cells. Dr. C.: You got it. Fortunately you haven’t damaged it enough, that you have to be that concerned. Next 17A please? B: Two shrimp guarding the heart or two monsters breaking it in half. Dr. C.: And what does that make you think of. How do you feel looking at that? B: Well I have had dreams about monsters breaking hearts in half and tearing people apart and stuff. But it looks like two shrimp guarding the heart because they are surrounding it. Dr. C.: How do you feel about those dreams, those dreams when monsters are tearing the heart apart? B: Usually it depends on whose heart they are tearing apart. Dr. C.: Can you expand on that please? B: Well even when I have dreams like that it is my step father’s heart and I’m all for it. Dr. C.: Can you tell us about the guillotine dream? (She had first revealed this earlier in a group psychotherapy session.) B: Oh. I was walking down the street, and I was in the lead. I had some friends from the hospital that I had met, and my step dad, and we were marching down the street and he was crying. We were all laughing at him. We would slap him and hit him and trip him and stuff, and he kept crying and saying, “Let me go, let me go. I’ll leave you alone.” And we would just laugh at him. And when we got to this hill, and we went up the hill and we were walking in a single file line and there was no way that he could get away and he was still 96 Cassell & Dubey

crying and we were laughing at him. At the top of this hill there was a guillotine. It was really sharp. And we got to the top of the hill and we all started tearing his clothes off. One at a time, somebody would put a finger on the stump and cut the rope and the blade would come down and chop his finger off. And everybody would take turns. And after they cut his finger off and they went to the back of the line. We did all the fingers, then we did the toes and then cut his hand off at the wrist and then his ankles, and then his knees and his hips, but even after we had cut him all up he was still alive. He could still feel all the pain because his legs were moving, his fingers were bending. After he was all cut up and everything? Dr. C.: What was the last part? B: I had, I don’t know really how I held him there, but he was standing in front of the guillotine, his legs were cut off but he was still there, and his dick was on the stump and I cut it off. And then I chopped him up and made him eat it. Dr. C.: How did you feel at that point? B: I felt good. Dr. C.: What about 18A? What do you see there? B: A priest calling the fires of hell to rise and surround him. He has his arms up beckoning. He is on a tall black pedestal. Dr. C.: And how do you feel looking at that? B: I have dreams about this too. It looks like he is there and his arms are up, up here. And this is the pedestal. In the video these were red and purple. And it looks like hell because this is all darkness down here. And it looks like he is calling up and they are rising up to surround him. Dr. C.: And what does that relate to you as far as you are concerned? B: Well nothing as far as I am concerned. That is what I saw when I saw the picture. Dr C.: Does it remind you of the cult worship, or satanic. B: Yes. Dr. C.: What is the association? B: Well the fires from hell. Dr. C.: Okay. 25A. B: It looks like a vagina or the mouth of a rattle snake striking at your face. That is what it looks like. That is what the inside of a rattle snakes mouth looks like. Dr. C.: Has any of the sexual abuse you had affected your feelings about your sexuality? B: Do you mean, do I still enjoy sex? Dr. C.: Okay. B: Yes, I do, very much. Dr. C.: What is the association with the sexuality and the rattlesnakes. B: You mean, have I done it with a rattlesnake? No. I don’t understand the question. Dream and SIS Images 97

Dr. C.: That’s okay. I just wondered about the association. (In the training video, it was premature to explore further this violent sexual symbolism. It was left for a female psychotherapist in her residential treatment facility to eventually to explore.) How about 1B? B: It looks like a woman in pain and there is another person coming out of her. Looks like blue clouds coming for their souls and they are taking them. Dr. C.: And how do you feel looking at that? B: It looks like a woman giving birth to a child and their soul is being taken from them. Dr, C.: What do you think of that when it happens? B: I think she has sold her and her child’s soul to the devil and he is coming for them. Dr. C.: And how does that relate to your life? B: Because I already sold my soul to Satan. Dr. C.: And 2b? B: It looks the demon with the blood of somebody in its brain. Big eyes, long antennas coming its from fangs. Steam from the mouth is coming out. And how do you feel about that. And what is that about do you think? B: I like demons. I like to read about them, I like to think about them. .J: Would you like to be one? B: No, I think they are interesting. Dr. C.: What do you mean by that J., I’m sorry? J: She would like to be one? Dr. C.: What makes you say that? J: I don’t know, she likes power… and demons have lots of that. Well I figure that demons have lots of that. I know if I seen one they would have total control. If they told me to do something, I’d do it. Dr. C.: What do you think about what J. is saying? B: His is probably right. Dr. C.: How about 3B? B: Looks like two people with their souls coming out behind them as they are having a sacrifice. The glow behind them is fire, hate and the blue below them is light of life. Dr. C.: And how do you feel looking at that one, and what is it about do you think? B: Well when you sacrifice something, that the soul of whatever you are sacrificing is automatically given to Satan and he is taking them. Dr. C.: And 4B is somewhat the same theme? 98 Cassell & Dubey

B: I see two people. One is evil, the red one. He is larger than the blue good one. Evil wins. Because in the movie he was red and this was blue. The red is bigger and overlapping. Dr. C.: In what way is there a battle between good and evil in you do you suppose? B: In lots of way. Dr. C.: We all have that. That is not just you, that is J. and me, everyone. But what is it for you? B: Well I mean it is whether to use or not use, or kill or not kill or steal or not steal. Things that I have done in the past. Dr. C.: Okay…and then the theme 25B, also continues there? B: Two demons guarding the soul of a good person and the soul is dying. Dr. C.: What is happening? B: The power of evil is a strong thing! J: So is the power of good! Dr. C.: J. do you have some reactions to some of these that she has seen…and also to her reactions to some of the images and all. J: No. I am kind of sitting here thinking, that God, because I believe in God, it just makes me think, I know she believe in Satan and obviously he doesn’t care about her and God you know obviously, with me he doesn’t care about me, because we both ended up in the same place. We both have problems. Not really the same problems, but both problems and it are how we deal with it. And we have the right to believe in what we want to believe in. I see those things. I didn’t see half the things she did though. Dr. C.: What way has your therapy changed you, as far as hopefully reinforcing the good parts and minimize the more evil parts. B: Well I decided that I don’t want to kill my step-father any more. We pressed charges against him and he is probably going to go to jail and I think that is punishment enough for him. Dr. C.: It took some courage to do that, but it was the right thing. B: And while I was here, there was a certain girl that I really wanted to hurt really bad and I controlled myself. Dr. C.: That was good. Could you share why you were so angry with her? B: Jealousy. Dr. C.: I think you made a lot of progress. Can you see that progress J? J: Yes, from what I hear from the way she used to be. I look at her and I wouldn’t suspect it. Dr. C.: Thank you both for sharing very much. At this time I think we will get some comments from S. and after that we can go after that cake. Dream and SIS Images 99

Psychiatric Nurse Interview: Dr. C.: I wondered S. if you could tell us your impressions of B. when she first came in and how the SIS-II Video played a role in her therapy. S: When B came in she had lots of anger, lots of homicidal impulses. Our major concern was the homicidal impulses towards family members and her suicidal ideation…the incident described by the documentary about the knives. It was very difficult to talk to her at first. She was not one to disclose any feelings. Dr. C.: It was hard for her to trust initially. S: Yes. As the primary nurse on unit, I tried to get that relationship built as quickly as possible. When we did the first SIS, lots of information came out, as you can tell from this film, lots of the anger and the violence, the cult, all things that we were not totally aware of in the beginning of how serious these issues were. Dr. C.: Can you see how her responses were related to some of the horror of her life, including her dreams? S: Yes, I participated in many of the dream groups and lots of violent past sexual abuse, lots of violence related to the use of drugs and alcohol…lots of inhalants. Dr. C.: And the tragedy of the evil exposure to cults. Did you want to comment on that? S: The cults have been a concern of ours, but the dreams seem to be the most therapeutic way that it has come out. And in the SIS also, there are several pictures that she described that was directly related to that. But the dreams are much more descriptive and much more violent. And more real to her and what her inner feelings are. Dr, C.: Which if the SIS responses would you like to comment on and maybe you have something to add. S: The one that I feel that has much more inner meaning to it than B. sees, is the one with the snake and the vagina related to the past sexual abuse. There is some more work that can be done there. That is a concern that she is not seeing the correlation just yet. The other ones that concern me, like I said, the violence, the real violence related. You see a lot of abandonment. You see a lot of those in several. I really can’t remember the exact numbers of them. Dr. C.: It was interesting to see how J. saw things differently, did you want to comment on his responses on any of them. S: J.’s responses in particular are much less violent, but the one that stuck in my mind was the one with the, male figures face and that he failed to identify the father figure. ..and J’s father very much did abandon him and the family. He is currently working on that. Dr. C.: The abandonment. S: We are currently working on that right now. Dr. C.: Before ending S., would you please comment on how working with such troubled teenagers and then viewing the video interview affected you emotionally. 100 Cassell & Dubey

S: You deal with such deeper issues with the adolescents and it brings back almost the shocking feeling…You feel very shocked at this much anguish and pain. Dr. C.: Does it touch on any of your own issues in the past, or have you been fortunate. S: It brings back some of the sadness related to family issues and having to relive some of the issues through the patients eyes of feeling abandoned or the anger and the responses you would have felt as an adolescent if you had some kind of trauma, a family crisis or a loss. Discussion: Congratulations for having survived an empathetic imaging mental voyage. Most caring professionals find that therapeutically entering the fragmented body-mind-spirit inner world of an adolescent suffering from Dissociative Amnesia can be stressful. The same applies for empathizing with a paternal impoverished adolescent such as J., but less so, because he appeared more intact. No doubt meeting either of them on a secluded dark inner urban street in America might cause your heart to pound. Your fear of violence would likely be magnified, if they and their peers manifested aggressive behavior consistent with the disinhibiting effect of alcohol or drugs. As a starting point for discussion, the information provided by the psychiatric nurse will be first reviewed. She commented on how B. during the first days of hospitalization showed reluctance to “disclose” her feelings. It was indicated how the SIS-II Video, during this phase triggered the release of memories relative to the B’s traumatic past. She noted the multiple similarities in dream and SIS evoked imagery. This connection has been a fundamental aspect of SIS diagnostic/treatment work (Cassell and Dubey,1997, Cassell, Dubey and Roth, 1997, Cassell, et al 2001). Both tap into the same underlying stream of violent fantasies, somatic sensations, Disociative Disorder “flashbacks”, hallucinations and posttraumatic dreams (Cassell and Dubey, 2000,2004, Cassell, Dubey, and Dubey, 2000, Cassell, 2005). Lacking training with the SIS, of the two modalities, she felt more comfortable in psychotherapeutic dream work. She selected 25A as the one, which to her had the most clinical relevance. It may be recalled that B. initially responded “A vagina” reflecting heightened sexual awareness, for a girl her age. She was concerned that this anatomical image was immediately displaced by:” The mouth of a rattlesnake striking at your face.” She correctly observed that B. needed much more work in follow-up residential treatment regarding her traumatic sexual past. For those trained during the era of when psychoanalysts had undue power in medical schools, this SIS response might brings to mind the now out of favor psychoanalytic concept “Dentate vagina”. In this context, J. pointed out that B. was motivated by satanic “Power” and she agreed. At one level, the “Snake’s mouth” symbolically could denote a wish to control and punish males through symbolically castrating sex. Recall the “Guillotine” dream, which incorporated ever more severe mutilation images of her stepfather. It culminated in a castration scene in which she is an incredibly powerful person. Her magic power at the climax enables her to make him eat his penis. This exaggerated sense of personal omnipotence with its concomitant sexual-aggressive issues had been acted out earlier on the hospital ward. This had occurred when a fantasized erotic relationship with a boy on the ward been threatened. At the time she experienced intense jealousy and murderous impulses towards the girl. Staff had to temporarily restrain her. Dream and SIS Images 101

It may be recalled that when B. was giving negative associations to 25B, she imagined seeing “Two demons guarding the soul of a good person and the soul is dying”. This reflected her satanic colored bias that evil is more powerful than good: “The power of evil is a strong thing!”. Her bizarre response to 25A, like many, illustrated how easily reality related external perception could be undermined by distorted past visions. For her, the SIS stimulated the release of posttraumatic dream imagery, such as that with 1A. She was traveling on a psychological path that bordered reality on one side, and psychosis on the other. If untreated, such severely traumatized adolescents may continue in adulthood suffering from one of the Dissociative Disorders or a “Borderline Personality”. Her precarious sense of identification and fragile reality testing was strongly symbolized in her associations to 19B/ She selected this one as the most disliked: “It looks like a globe and it is full of cracks…and then it looks like tentacles or something coming out from the world…I said that it looks like a stamp because it looks like a picture that could be a stamp…and I wrote that it looks like the world where all the love is broken and the arms are reaching out for help…it makes me sad because the world broke apart…there is no love in it”. For the treatment staff discussing her long term prognosis, 19B brought to mind the poem parents in western culture recite to children: ”Humty Dumpty sat on the wall, Humpty Dumpty had a great fall, All the kings horses and all the kings men could not put Humpty Dumpty together again.” In severely traumatized individuals, it is one thing to for clinicians to understand dream/SIS symbolism. It is quite another thing to expect real and clinically measurable therapeutic outcome from simply interpreting it. This is one of the major reasons that the earlier psychoanalysts had relatively poor treatment results. It is noteworthy that the symbols “Monster” and “Demon” that terrorized her dreams also are incorporated into her inkblot projections. Several symbolized both her fear of abusive stepfather, as well as parts of herself that have identified with his evil power. She found in the external satanic culture a supportive group who reinforced the sadistic and violent aspect of this complex. No doubt the western culture flames such feelings in twenty first century adolescents. Modern media tends to flood viewers with sexual/aggressive vivid and symbolic imagery. Now many television and movie plots portray the evil figures as being more powerful than the law abiding. Given the widespread history of wars and other sanctioned violence, perhaps this fascination is wired into the DNA of Homo Sapiens. In the modern era it illustrated by the use of rape as a political weapon in Bosnia and in the Sudan, as well as a variety of sadomasochistic practices used by perverted people worldwide. At this stage of the discussion one fundamental question might be briefly examined: Did the independent projective data support or refute her original claims of having been mesmerized by the Devil in Arizona? This has more than academic heuristic interest. There are significant diagnostic and legal the implications of naively believing such reports. In regard to human sacrifice in activity in America, an informed representative of the FBI’s behavioral unit testified as an expert witness at a cult related trials: “There is no physical evidence of human sacrifice rituals to support their existence”(i.e. Discovered human bones etc,) Yet the FBI take cults seriously, as reflected in a comprehensive bulletin published for law enforcement officials: “The Interacting With Cults”. 102 Cassell & Dubey

In this context B.’s associations to 5B, her favorite one, might be relevant: ”Sharing thoughts without words…just brain waves” might be consistent with a past indoctrination with evil rituals and related nonverbal mesmerizing satanic practices. These practices could have involved the use of skulls, as reflected with her response to 30A, her third most liked one. It has been previously reported (Cassell, 1979) that the projection of certain types of anatomical responses can symbolize preoccupation with death. Her repeated emphasis on how the satanic activity made her “Happy” is noteworthy. It could signify real life exposure and resultant morbid addiction to death symbols, sacrificial practices and Devil worship. Several other SIS responses are consistent with her claims. For 1A, the evoked “Monster” imagery stimulated memories of her disturbing dreams and her selling her soul to Satan. Again she spontaneously reported having participating in satanic rituals “To make Satan happy”. Her visualization of a satanic priest with 18A was not prompted by any leading question. Finally in this vein, for 3B she projected material denoting an act of sacrifice. Yet she may have fabricated the whole cult story. There could be alterative explanations. One basic one might relate to her response to 19B, the most disliked SIS stimulus. It may be recalled that she visualized this as a “Broken world”. The subsequent enquiry led to speak about her abusive sexual relationship with her stepfather. This theme again came up with 17A. It could well be that he was the one symbolized by “Monsters” both in her projective imagery and dreams. Moreover, she may have conceptualized of her perpetrator in a concrete way, based upon her fundamental Christian religious background as the “Devil”. As a teen-aged girl this may have led her to fantasize about killing him, as vividly presented in her “Poem”. Such daytime fantasies then could have spilled over to her dreams as day residual. The same mechanism could as well have influenced her SIS responses. Theoretically these mechanisms could have made her vulnerable to satanic practitioners, if in fact her claims were based upon reality. It was hoped that her planned long-term residential psychotherapy would eventually clarify such murky issues. Next a review will be given of J.’s responses starting with 25B.Immediately after B. implied that evil was more powerful than good, J. challenged her by exclaiming “So is the power of good!” This positive spirituality was an inner resource to help him over his emotionally traumatic episodes. It also made him more amenable to group psychotherapeutic work including the concept of “A Higher Power” to deal with his chemical abuse problems. His response to his favorite SIS stimulus 10A reflected his euphoric state during glue induced hallucinations. Here the SIS structure triggered the release of dormant toxic images in the brain’s visual memory systems. This illustrated how SIS pictorial structure provides an effective interview stimulus for clinically investigating the validity and nature of past visual hallucinations. His second most liked one 6A, symbolized his wish to avoid adolescent turmoil and depression by magically regressing to childhood. For him it was only a fantasy. Apparently he was never happy like the little boy portrayed. His adolescent sadness surfaced in his selection of 14B as his third favorite one. Initially what attracted him was that it brought back memories of his “Baby Momma”. Her loss triggered the depression and suicidal behavior, which led to his hospitalization. Concurrently it activated dormant memories of his childhood sadness and anger about abandonment by his biological father. Dream and SIS Images 103

Prior to hospitalization his violence, impulses regularly surfaced when he was under the influence of mind altering chemical substances. He carried a knife for fighting. Reflecting these violent episodes, he had scene specific posttraumatic dreams. His response to 15B is noteworthy: “It is a thing, and there is a bunch of knives being thrown at it…he has to do what they say…so I put that down as the hospital that I’m in…you have to follow the rules…you have to do it or you are going to cut…you will be here no longer.” The initial SIS structure that he focused on was first perceived primitively as an inanimate object -“A thing”. There was a definite perceptual inhibition time delay before he substituted the image of a human male – “He”. However, the stress specific SIS structure of sharp objects pictorially depicted in 15B likely would have stimulated anxiety laden memories of his real life knife fights and their symbolic traumatic dreams. Consequently the following defensive content was substituted: “I put that down as the hospital I am in”. This was at a lower level of threat but still disconcerting to him. When the treatment team learned of this defensive substitution, the members expressed definite concerns. His SIS projected attitude to “Rules” showed how resistant he was to accepting the external social controls implicit in a psychiatric facility. The staff feared that the same would apply to any scheduled post hospital treatment. Next, his experience in not seeing adult male facial structure in 4A will be discussed. He became angry even though he failed to cognitively identify the embedded SIS content. His brain’s perceptual system may have connected this to his previously programmed childhood fantasies about his absent biological father’s facial appearance. This formulation is consistent with early clinical work suggesting that disturbing affect can be experienced in awareness, even in projective situations were depicted reality structure of a SIS stimulus doesn’t register (Cassell, 1969,1971,1972,1980). In spite of having experimented with gas inhalation, he was not sufficiently brain damaged to account for this failure. In contrast to 4A, with 6A he was able to visualize “a wish fulfillment” image of a “Happy little boy and teddy bear”. Moreover, he did not have “Blindness” on the basis of some other mental condition such as Conversion Disorder. Over the years the complex issue of failing to detect prominent SIS structure has been examined in various clinical contexts (Cassell, 1998, Cassell, andDubey, 2000). It continues to present challenges in theoretical nomenclature and understanding for SIS clinicians. It is anticipated that clarification may come from research in the visual cognitive sciences on “Psychological” Blindness”, as well as from the basic neurological sciences. Of course observations based upon a single case history only can generate hypotheses. Moreover, the interpretations that you read are those solely of the author. No doubt you may have your own unique “projections” based upon a different theoretical background and personal life experience. There is no valid physical standard of measurement in this field, as there is for scientists measuring distance. Controlled statistical studies are required to determine, if as a group, males who lack a biological father have difficulty in identifying adult male SIS structure. It would be erroneous to contend that all fatherless Black males are vulnerable to such problems. Many are able to identify with appropriate male role models and eventually function at high levels in society. It was unfortunate for J. that he had partially identified with his school coach who introduced him to mind altering drugs. 104 Cassell & Dubey

When the training video on violence was planned, J. was included as a secondary supportive character. Yet his problem in identifying adult male SIS structure is of such interest to warrant a brief cultural consideration. Many behavioral scientists contend that there is an ongoing overall feminization of western culture, especially evident in Black families. The majority of teachers are women. In many countries, there has been a trend for fathers to be absent with concomitant school failure, teen pregnancy, drug problems, crime and violence. It is a challenge to objectively discuss this without seeming racist and/or sexist. Not vulnerable to the former criticism, a few American Black leaders have had the courage to risk their public images by addressing the issue. In June 2005 for example, USA senator Barrack Obama observed: “There are a lot of folks, a lot of brothers, walking around, and they look like men, and they are tall, and they have got whiskers - they might even have sired a child. But it is not clear to me that they are full grown men. This tend is not just confined to the USA. In a November 2005 editorial in the Toronto Globe and Mail the following statistic was reported a single parent is now raising Two in three Jamacian-Canadian children in violent torn areas of Toronto. The editor also noted that in Briton, Trevor Philips the chairman of the Commission on Racial equality, who is black, a month earlier, criticized “the almost casual acceptance” that most black children grow up fatherless. Some are attempting to combat this trend with publications and Internet support for fathers (e.g.”DAD” at www.dad.co.uk) Girls’ lives too, are impoverished in fatherless families. Apart from the lack of psychological-spiritual positive bonding with a paternal figure, there are other difficulties, some socioeconomic. Unemployed black males can gain indirect economic benefits associated with having a pregnant girl friend whose food and apartment are paid for by welfare. A girl’s boyfriend may insist upon impregnating her long before she is psychologically prepared for the role of mother. Blacks refer to such a victim as a “Baby Momma”. J. was getting indirect financial support from his teenage girl friend before she jilted him because of his violence. In order to comprehensively understand such a Black youth’s propensity for violence, it is necessary to factor in the implications of his poor economic situation. These two cases raise many serious socioeconomic problems, well beyond that relatively limited scope of this phenomenological study. Their histories illustrate how dream/SIS image linkage can provide an innovative methodology for the in-depth study and clinical management of adolescent violence. Some of the findings may provide guidelines for more broad based future scientific studies on the dark and violent side of human nature. References: Cassell, W.A. (1969) Response to Inkblot Configurations Resembling the Heart J. of Projective Technique and Persononality Assessment,. 3: 123-126 Cassell, W.A. (1972) Individual Differences in Somatic Perception. Advances in Psychosomatic Medicine. 8:86-104 Cassell, W.A. (1977) Aggressive Symptoms and Clinical Symptoms in Schizophrenia. British J. of Projective Techniques, 16: 21-31 Cassell, W.A. (1979) Anatomical Rorschach Responses and Death Symbolism. British J. of Projective Techniques and Personality Study, 24:7-16 Dream and SIS Images 105

Cassell, W.A. (1980) Body Symbolism and the Somatic Inkblot Series, Anchorage Alaska Aurora Publishing, Cassell, W.A. 1991) Art Therapy Using the SIS-II Video, Japanese Bulletin of the Arts Therapy, 22:131-135 Cassell, W.A. (2001) SIS Explorations of Human Consciousness. SIS J. Proj. Psy. & Mental Health, 8: 3-14 Cassell W.A. (2005) SIS Stimulation of Beacon Imagery, SIS J. Pro. Psy. & Mental Health, 12: 3- Cassell, W.A. and Dubey, B.L. (1997) Therapeutic Dream Stimulation with the SIS-II Video. SIS J. of Pro. Psy. & Mental Health, 4: 3-23 Cassell, W.A. and Dubey B.L. (1998) Application of Somatic Inkblot Series in Personality Assessment, Screening and Diagnosis and Therapy SIS J. of Proj. Psy & Mental Health, 5: 3-32 Cassell. W.A. and Dubey, B.L. (1998) Mental Disorders Triggered by Exposure to Violent Imagery in the Media and Electronic Games. SIS J. of Pro. Psy & Mental Health, 5: 87- Cassell W.A. and Dubey, B.L. (2000) SIS Inkblot Responses as an Aide to Therapy SIS J. of Pro. Psy. & Mental Health, 7: 3-10 Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot Series, SIS Center, 4501 EAST 104TH Avenue, Anchorage Alaska 99507 (USA) Cassell W.A. and Dubey B.L. (2004) A Nervous System Based Model for SIS Inkblot Projection and Consultation SIS J. of Pro Psy. & Mental Health,11, 2:95-104 Cassell, W.A., Dubey B.L., and Molchanov E. (1999) Stimulating Beacon Images for Meditation and Projective Psychotherapy SIS J. of Pro Psy & Mental Health, 6:89-112 Cassell, W.A., Dubey, A. and Dubey, B.L. (2000) SIS Projective Responses in PTSD and Disociative Disorder SIS J. of Proj. Psy & Mental Health, 7:93-108 Cassell, W.A., Ilardi F, Mishra M. and Dubey B.L. (2001) Optimizing Spiritual healing by Assessing Dream and SIS Imagery, SIS J. of pro. Psy. & Mental Health, 8:75-94 Cassell W.A., Schaeck, A.M. and Mohn. D. (2002) Symbolism in Violent Hallucinations. SIS J. of Pro Psy. & Mental Health, 9:81-92 SIS Journal of Projective Psychology & Mental Health at http:// www.somaticinkblots.com 106 Cassell & Dubey

Impulsivity in Eating Disorders: Analysed Through Wartegg Test Silvia Daini, Carlo Lai, Giuseppe Manuel Festa, Francesca Maiorino, Massimiliano Pertosa and Sergio De Risio Psychological and psychopathological characteristics in eating disorders (ED) were analyzed by Wartegg projective test on one-hundred ED female patients. Thirty-five patients diagnosed with Anorexia of restricting-type (ANrt), twenty-two patients diagnosed with Anorexia of purgingtype (ANpt) and forthy-three patients with Bulimia diagnosis (BL) (DSM-IV criteria and EDES questionnaire) were compared with eighty-one control subjects (CN). Wartegg test results, by a quantitative scoring system, show significant differences between ED patients and CN on depression, impulsivity, reality testing and aggressiveness. ANrt present anxiety, perfectionism and impulsivity; ANpt show lower formal quality than other qroups, and BL show depression and low self-realization. Wartegg projective test shows a significant unconscious or disguised impulsivity in restricting anorexic patients. Several studies suggest that eating disorders tend to be associated with other psychiatric disorders such as depression or depressive symptoms (Strober and Katz 1988; Casper et Al., 1998; Jacobi et Al., 2004) and anxiety or obsessive compulsive symptoms (Braun et Al., 1994; Deep et Al., 1995 ; Rastam et Al., 1995 ; Bulik et Al., 1997; Pollice et Al., 1997). Eating disorder diagnosis is also frequently associated with personality disorders: borderline personality disorder, obsessive-compulsive personality disorder and avoidant personality disorder (Piran et Al., 1988; Murakami et Al., 2002; Tomotake et Al., 2002; Slopien et Al., 2004; Milos et Al., 2002). Moreover other personality studies on eating disorders suggest the presence of specific psychological characteristics: body image dysfunction with body dissatisfaction (Garner and Garfinkel, 1981; Thompson et Al., 1995), negative self-evaluation and low self-esteem (Wagner et Al., 1987), perfectionism (Mitzman et Al., 1994), hostility, difficulty in social adaptability and in sexual identity, external locus of control, difficulty in impulse control and consequently acting out behaviors (Beumont et Al., 1976; Smart et Al., 1976; Wingate and Christie, 1978; Hatsukami et Al., 1982; Huon and Brown, 1984; Ordam and Kirschenbaum, 1986; Hall et Al., 1987; Norring, 1989; Casper, 1990; Williamson, 1990; Claes et Al., 2001). Social anxiety, interpersonal distrust and interpersonal isolation have also been emphasized as a co-morbid disorder by numerous authors (Evans and Wertheim, 1998; Diehl et Al., 1998). Although a heterogeneous psychopathological pattern indicates defining the diagnosis by a complete individual personality screening, a consistent number of studies seem to evidence two different patterns between anorexia and bulimia. While anorexia nervosa seems to be associated with anxiety disorders (Klein et Al., 2004; Strober, 2004) obsessive compulsive symptoms (Murphy et Al., Silvia Daini, Carlo Lai, Giuseppe Manuel Festa, Francesca Maiorino, Massimiliano Pertosa, Sergio e Risio, Psychiatry and Psychology Institute, Università Cattolica del Sacro Cuore, Rome, Italy, Corresponding Author: Silvia Daini. Instituto di Psichiatria e Psicologia, Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito 1, 00168, Rome, Italy, Mobile Phone: 0039 339 3798428, Tel/Fax: 0039 (0)6 3054850, Email: daini@katamail.com Key Word : eating disorders, impulsivity, projective methods, Wartegg test SIS J. Proj. Pst. & Ment Health (2006) 13 : 107-119

2004), difficulties in processing emotional information showing high alexithymia scores (Espina, 2003; Zonnevylle-Bender et Al., 2004) asceticism and perfectionism traits (Bell, 1985; Rampling, 1985 ; Huline-Dickens, 2000; Sutandar-Pinnock et Al., 2003) bulimia nervosa seems to be more related to mood disorders (Slopien, 2004) depression (Bailer et Al., 2004; Stice et Al., 2004), euphoria and bipolar spectrum (Kjelsas et Al., 2004; Katzow et Al., 2003) and particularly to borderline personality disorder (Meyer et Al., 2001; Fassino et Al., 2003) and impulsivity (Vervaet et Al., 2004; Brewerton et Al., 1993; Bruce et Al., 2003; Fahy and Eisler, 1993; Verkes et Al., 1996). These different psychopathological patterns should be related to specific character traits such as increased “harm avoidance” and “self-directedness” which might be relevant in anorexia nervosa and increased “harm avoidance” and “novelty seeking” in bulimia nervosa (Tomotake and Ohmori, 2002; Fassino et Al., 2003). As regards differences between anorexia subtypes (restricting and purging), actual studies describe restricting subtype as more like healthy controls (Mond et Al, 2005), and purging subtype as more disturbed and with higher prevalence of Obsessive Compulsive Disorder( Speranza et Al, 2001). As a link between personality and treatment outcomes, in anorexics with lower EDI perfectionism scores at admission, a better response in inpatient treatment and a better outcome at follow up have been demonstrated (Sutandar-Pinnock et Al., 2003). In bulimics, the rate of drop outs from psychotherapy treatment was associated with impulsivity and anger, with less cooperation and less self-directedness (Fassino et Al., 2003). These evidences seem to demonstrate that both anorexia and bulimia involve pathological dynamics in the impulse area, where anorexics, who are particularly selfdirected, guide the impulses inside a framework of inhibition or complete negation, and bulimics, failing this, guide their impulses through acting out and explicit impulsivity. Although a lot of research has confirmed the differences between anorexia and bulimia, some studies have found high levels of impulsivity defined as potential (Lenihan and Kirk, 1990) or pseudoparadoxical (Fessler, 2002) in anorexics as well. Moreover clinical evidence, like changing therapists, interrupting treatment and compulsive nocompliance, suggest an important role of impulsivity in anorexic patients as well. It may be that, although impulsivity is present in anorexics, their perfectionism (Huline-Dickens, 2000; Sutandar-Pinnock et Al., 2003), acts like a disguising process of negatively considered behaviors, or that the defence mechanism of negation keeps impulsivity unconscious. This issue is useful in planning an effective therapeutic plan. In order to investigate psychological and psychopathological profile in eating disorders several studies have used inventories, interviews, behavioural, physiological, cognitive and perceptual tests. Although projective techniques give a complete frame on conscious and unconscious aspects of a patient’s personality, guaranteeing a major validity of diagnosis in relation to eventual disguising, few studies have used these techniques (Fagiani and Marocco Mattini, 1989; Narduzzi and Jackson, 2000; Garcia-Alba, 2004). This is probably related to difficulties in obtain quantitative data and interval scales through projective tests, which often require qualitative analyses and a longer time of application. 108 Pertosa & De Risio

The aim of this study is to investigate psychological and psychopathological aspects in patients with anorexia and bulimia nervosa through the Wartegg test (Wartegg, 1957), a diagnostic semi-projective technique that integrates gestalt and dynamic psychology. The Wartegg test, in according to the Crisi method (Crisi, 1998), allows a quantitative scoring system through a relatively short application time and with a good empirical validity of the codification (D’Amore, 2004). In order to test whether the quantitative Wartegg test differentiates between anorexic, bulimic and control groups, we hypothesized that while bulimic group presents a pattern in the borderline spectrum with depression and impulsivity, anorexic group presents a paradoxical psychopathological pattern in the anxiety spectrum with affectivity hyper-control, perfectionism and impulsivity. Methods: Participants and Procedures: One hundred female patients with eating disorder participated in this study. They were 100 out-patients at the Gemelli Hospital, between 1999 and 2004, referred to the Psychiatry and Psychology Institute in order to receive diagnosis and therapy. Eating Disorder diagnoses were made following DSM IV criteria (APA, 1994) and through the EDES questionnaire (Vandereycken, 1993). 35 patients were diagnosed with Anorexia of restricting type (ANrt); 22 patients were diagnosed with Anorexia of purging type (ANpt) and 43 patients with Bulimia diagnosis (BL). All patients performed structured clinical interviews (SCID by DSM IV) and the following tests: IPAT-CDQ, IPAT-ASQ, drawing tests (Draw a person, Baum test, Family Drawing), the Rorschach test, the Wartegg Test and routine medical examinations. The Wartegg test results are the focus of this study. The data in this study was collected during the diagnostic phase before treatment. The clinical group was compared to 81 control subjects (CN), matched for sex, educational and socio-economic status and recruited from the university community. The mean age of all participants at the time of the interview was 23,7 (SD= 5,9). Anorexic of restricting type participants (mean age 21,4 years; SD= 6,5) were significantly younger than bulimics (mean age 24,3; SD= 6,6 -p< ,05) and controls (mean age 24,4; SD= 5 -p< ,01). In the analyses the age variable was considered as covariate. Measures: The Wartegg test is a projective procedure. It is composed of eight panels with eight semi-structured stimulus-signs. The subject is invited to draw a meaningful picture for each of the eight panels starting from the stimulus-sign. Through these stimulus-signs, each panel suggests different psychological dimensions and elicits answers in profound areas of personality (Wartegg, 1957). From an integration of different proven interpretations in several studies (Falcone et Al., 1986), we can describe the panel’s characteristics: panel 1 is related to the actual state of identity, panel 2, vitality and sensibility, panel 3, ability to direct own psychic resources towards aims and objectives, panel 4, relation to rules and authority, panel 5, directionality of aggressive dynamics, Impulsivity in Eating Disorders 109

panel 6, integrity of reality testing, panel 7, relation to femininity, and panel 8, social relations. The tests were codified according to the A. Crisi scoring system (Crisi, 1998). The Evocative character (EC), the Affective quality (AQ), the Formal quality (FQ) of graphic answers for each of the eight panels of all 181 tests, were determined. For each test the Anxiety Index, the Impulsivity Index, the EC, the AQ, the FQ total index and Primary Contents were calculated. The Evocative character gives information on how the subject, both from a purely perceptive-gestalt and associative point of view, reacts to the stimulus-signs of the test. The EC focuses on the perceptive function and the associative processes of the subject. It describes his symbolic ability to perceive and process stimuli in the environment. The scores vary between 0, if the evaluation of the picture completely fails the stimulus-sign of the panel; 0,5 if the evaluation only partially integrates the stimulus-sign; 1 if the evaluation fully integrates the stimulus-sign. The Affective quality evaluates the connotative meaning of the content of the drawing. The AQ describes the affective trend and quality of the subject’s relation to the environment. The scores vary between 0 when the subject draws emotionally negative content; 0,5 when the subject draws emotionally neutral content and 1 when the subject draws emotionally positive content. The Formal quality evaluates the cognitive integrity of the subjects compared to their reality testing. The scores vary between 0 when the meaning is unclear or unrecognisable; 0,5 when the meaning is only recognisable after clarification from the subject; 1 when the meaning is immediately recognisable. Anxiety Index varies between 0 and 1. It is the ratio between the eight panels and those with deleting or blackening. The Impulsivity index varies between 0 and 1. It is the ratio between the eight panels and those with overtaking frame, where in the drawing has gone over the panel margins. The scales were coded by two independent scorers. On a randomly selected sub-sample of 40 Wartegg tests, the inter-rater reliability for EC AQ FQ (min K= ,79; max K= ,82; mean K= ,80) and for the Anxiety Index (r= ,80; p<,0001) and the Impulsivity Index (r= ,88; p<,0001) was good. The Primary Contents of all the panels have been codified using a list of 6 categories: human, animal, object, nature, abstract, refused answer (void). Statistical Analyses: Statistical Analyses were performed using Statistica 5.1 version for windows by StatSoft. Inc. Analyses of variance (MANCOVAs and ANCOVAs) with Post-Hoc test and covarying subject age variables were conducted to test the effect of the diagnosis (ANrt ANpt BL CN) on the Wartegg test measures. Moreover in order to test if the distribution of primary contents varied between the four groups (restricting anorexics purging anorexics bulimics and controls) a Chi square analysis was performed. 110 Pertosa & De Risio

Results: To further investigate if the measures of the Wartegg test differentiate between the groups of restricting anorexics, purging anorexics, bulimics and controls, on all 181 subjects, four MANCOVAs over eight Evocative character scores (Table 1), the Affective quality scores (Table 2), over eight Formal quality scores (Table 3), and the Anxiety / Impulsivity Indexes (Table 4) and a Chi square analysis on Primary Contents was performed. Table1 MANCOVA Diagnosis (ANrt, ANpt, BL, CN) per Evocative Character scores in eight panels with age variable as covariate Rao R= 0,99 Anorexic RT Anorexic PT Builimic Control F LSD (24,490) Group (N: 35) Group (N: 22) Group (N:43) Group ( N:81) (3,176) Post-Hoc P: NS Mean (SD) Mean (SD) Mean (SD) Mean (SD) test Panel 1 0,80 (0,4) 0,82 (0,3) 0,83 (0,4) 0,89 (0,3) 0,6 Panel 2 0,77 (0,4) 0,77 (0,4) 0,80 (0,3) 0,75 (0,4) 0,2 Panel 3 0,61 (0,3) 0,79 (0,3) 0,60 (0,3) 0,56 (0,3) 3,4* ANpt>ANrt* ANpt>BL* ANpt>CN** Panel 4 0,53 (0,5) 0,68 (0,4) 0,64 (0,4) 0,52 (0,5) 1,1 Panel 5 0,82 (0,3) 0,74 (0,3) 0,80 (0,3) 0,85 (0,3) 1,4 Panel 6 0,83 (0,3) 0,77 (0,4) 0,89 (0,3) 0,89 (0,3) 1,4 Panel 7 0,50 (0,4) 0,51 (0,5) 0,49 (0,5) 0,51 (0,5) 0,2 Panel 8 0,73 (0,3) 0,80 (0,3) 0,79 (0,3) 0,75 (0,3) 0,4 Total 0,70 (0,1) 0,74 (0,2) 0,73 (0,1) 0,71 (0,1) 0,5 Table 2 MANCOVA Diagnosis (ANrt, ANpt, BL, CN) per Affective Quality scores in eight panels with age variable as covariate Rao R= 0,99 Anorexic RT Anorexic PT Builimic Control F LSD (24,490) Group (N: 35) Group (N: 22) Group (N:43) Group ( N:81) (3,176) Post-Hoc P: NS Mean (SD) Mean (SD) Mean (SD) Mean (SD) test Panel 1 0,76 (0,4) 0,66 (0,3) 0,69 (0,4) 0,81 (0,3) 2,1 CN>BL* Panel 1 0,76 (0,4) 0,66 (0,3) 0,69 (0,4) 0,81 (0,3) 2,1 CN>BL* Panel 2 0,67 (0,7) 0,60 (0,6) 0,74 (0,7) 0,78 (0,8) 1,5 CN>ANpt* Panel 3 0,64 (0,3) 0,57 (0,2) 0,58 (0,2) 0,68 (0,2) 1,9 CN>BL* Panel 4 0,59 (0,3) 0,48 (0,3) 0,46 (0,3) 0,58 (0,3) 1,8 Panel 5 0,54 (0,2) 0,54 (0,1) 0,55 (0,3) 0,59 (0,2) 0,5 Panel 6 0,56 (0,2) 0,48 (0,2) 0,60 (0,2) 0,59 (0,2) 1,5 CN>ANpt* BLt>ANpt* Panel 7 0,73 (0,3) 0,57 (0,3) 0,64 (0,4) 0,68 (0,3) 1,2 Panel 8 0,64 (0,4) 0,61 (0,3) 0,65 (0,4) 0,73 (0,3) 0,8 Total 0,64 (0,2) 0,56 (0,1) 0,61 (0,1) 0,68 (0,2) 4,1** CN>ANpt** Impulsivity in Eating Disorders 111

Table 3 MANCOVA Diagnosis (ANrt, ANpt, BL, CN) Formal Quality scores in eight panels with age variable as covariate Rao R= 0,99 Anorexic RT Anorexic PT Builimic Control F LSD (24,490) Group (N: 35) Group (N: 22) Group (N:43) Group ( N:81) (3,176) Post-Hoc P: NS Mean (SD) Mean (SD) Mean (SD) Mean (SD) test Panel 1 0,86 (0,3) 0,77 (0,4) 0,88 (0,3) 0,93 (0,2) 2,0 CN>ANpt* Panel 2 0,86 (0,3) 0,82 (0,3) 0,94 (0,2) 0,91 (0,2) 1,4 Panel 3 0,90 (0,2) 0,73 (0,4) 0,76 (0,3) 0,89 (0,2) 4,2** ANrt>ANpt* ANrt>BL* CN>ANpt* CN>BL** Panel 4 0,81 (0,3) 0,73 (0,4) 0,84 (0,3) 0,88 (0,3) 1,4 CN>ANpt* Panel 5 0,77 (0,4) 0,73 (0,4) 0,79 (0,3) 0,92 (0,2) 4,8** CN>BL* CN>ANrt* CN>ANpt** Panel 6 0,86 (0,3) 0,79 (0,4) 0,87 (0,3) 0,92 (0,2) 1,8 CN>ANpt* Panel 7 0,91 (0,2) 0,75 (0,4) 0,81 (0,3) 0,90 (0,3) 2,4 CN>ANpt* ANrt>ANpt* Panel 8 0,97 (0,1) 0,86 (0,3) 0,95 (0,1) 0,97 (0,1) 3,0* ANrt>ANpt* BL>ANpt* CN>ANpt** Total 0,87 (0,2) 0,77 (0,3) 0,86 (0,1) 0,92 (0,1) 6,1** ANrt>ANpt* BL>ANpt* CN>ANpt** *: p<,05; **: p<,01 Table 4 MANCOVA Diagnosis (AN, BL, CN) per Anxiety and Impulsivity Indexes with age variable as covariate Rao R= 0,99 Anorexic RT Anorexic PT Builimic Control F LSD (24,490) Group (N: 35) Group (N: 22) Group (N:43) Group ( N:81) (3,176) Post-Hoc P: NS Mean (SD) Mean (SD) Mean (SD) Mean (SD) test Interior 1,20 (0,4) 0,98 (0,3) 1,02 (0,5) 0,91 (0,4) 4,0** ANrt>ANpt* Tension ANrt>CN** Index Anxiety 0,80 (0,2) 0,66 (0,2) 0,69 (0,3) 0,62 (0,2) 4,1** ANrt>ANpt* Index ANrt>BL* ANrt>CN** Impulsivity 0,48 (0,3) 0,37 (0,3) 0,37 (0,3) 0,28 (0,2) 5,5** ANrt>CN** Index BL>CN* *: p<,05; **: p<,01 112 Pertosa & De Risio

The Evocative character scores (Table 1) don’t significantly vary between clinical and control groups. The Perceptive function and the symbolic capacity, therefore, appear similar in patients with eating disorders and in normal controls. Only on planning capacity where purging anorexics show higher scores than restricting anorexics bulimics and controls (panel 3: 0,79 vs 0,61 and 0,60; p<,05 and vs 0,56; p<,01) there are significant effect. The Affective quality scores (Table2) significantly differentiate the groups. On the total scores controls present higher score than purging anorexics (p<,01). Patients with eating disorders, whose many drawings showed negative emotionally content, indicated more depression than the normal women. Analytically this difference is related also to bulimics that, with respect to controls, show difficulties with identity (panel 1: 0,69 vs 0,81; p<,05) and planning capacity (panel 3: 0,58 vs 0,68; p<,05). Purging type anorexics show lower affective quality total scores than controls (0,56 vs 0 ,68 p< .01), and significantly lower scores on Panels 2 (p<.05), and Panel 6 (p<.05) ). Table 3 shows Formal quality analysis. Formal quality scores significantly differentiate the groups. In the total scores purging anorexics present a lower score than the controls (p<,01). restricting anorexics (p<.05) and bulimics (p<.05) Restricting anorexics don’t show significant differences from controls, except in Panel 5 (direction of hostility) and show a better formal quality than purging anorexics in Panels 3(p<..05), Panel 7 (p<.05) and Panel 8 (p<.05). In bulimics the rational and cognitive functioning presents impairments in relation to life planning (panel 3: 0,76 vs 0,90 of ANrt; p<,01) aggressiveness (panel 5: 0,79 vs 0,92; of controls p<,05). On the contrary, they show better scores than purging anorexics in Panel 8 ( 0,95 vs 0,86 ; p<,05). Table 4 shows analysis of anxiety and impulsivity indexes, that are significantly different between the experimental groups (p< .0001) Post hoc comparisons show an Interior Tension Index higher .in restricting anorexics compared to controls (p<.01) and to purging anorexics (p<.05). In the Anxiety Index, restricting anorexics show significantly higher scores with respect to bulimics (0,80 vs 0,69; p<,05), purging anorexics (0,80 vs 0,66, p<.05) and controls (0,80 vs 0,62; p<,01). About Impulsivity Index, both restricting anorexics and bulimics show significantly higher scores with respect to controls. Although restricting anorexics show particularly higher values (0,48 vs 0,28; p<,01) than bulimics . Chi square test of frequency of primary contents shows higher frequency of Abstract contents in restricting anorexics in front of bulimics and controls ( Chi square 15,4 p<.01) and fewer refused answers (Chi square 29,3 p<.01). This result suggests rationalization defences and perfectionism in restricting group. The experimental groups don’t show other differences from controls as to primary contents. Impulsivity in Eating Disorders 113

Discussion: Evocative character of the answers doesn’t show significant differences between groups. It seems that the capacity to find a significant relationship between the perceived stimulus and meaning is present in eating disorders. In this area the development of associative processes and the adaptation possibilities, highlighted by the congruence between the attributed meaning and the proposed stimulus, seem to be normal. This processing ability confirms the positive prognostic estimate for psychotherapeutic treatments that commonly appear efficacious for eating disorder patients. In eating disorder groups the process of constructing meaning is influenced by depression, particularly in purging anorexics From a psychopathological point of view, the dimension of depression in bulimics is related to personal identity, to self realization, and to respecting social norms. Guilt feelings apparently related to eating and purging seem to comprehend more profound and substantial personal dimensions. Formal quality analyses demonstrate that both purging anorexics and bulimics are unable to use aggressiveness and assertiveness to overcome obstacles. Moreover bulimics show impairment regarding their own femininity and sexuality, whereas restricting anorexics show a high level of rational functioning, comparable to normal controls. The data show that in this sample, restricting anorexics are anxious and potentially impulsive, as shown in the Indexes, and inclined to rationalization and perfectionism, as shown by number of abstract contents and voids, while bulimics showed higher levels of depression and impulsivity. in relation to self concept and real situation. Purging subtype of anorexia shows a distinct profile among eating disordered subjects: significantly lower affective quality, combined with lower formal quality, suggests a more profound depressive dynamics. As regards Contents of the Wartegg test, the presence of a lot of abstract drawings in anorexics seems to be an expression of negation of affectivie instances. Moreover the low frequency of empty panels and the frequency of full tests confirm the presence of perfectionism, as reported in many studies (Bulik et Al., 2003; Sutandar-Pinnock et Al., 2003). This pattern (affectivity negation and perfectionism) should be related to the rationalization defence mechanisms, which seems paradoxically more common in anorexic patients than in other two groups. Bulimic patients don’t show comparable rational defence mechanisms, but have heavier depression, and show a narrow link between unconscious dynamics related to identity and femininity and more explicit feelings of guilt and conflict with authority. This pattern suggests that bulimics evolved from a purely narcissistic to a partial object position (Parmer, 1991). The Wartegg test has proven to be useful in the qualitative analysis of single cases and in differentiating the characteristics of eating-disorder subjects from normal subjects. In fact depression, impulsivity and the failure of effective reality testing seem to be common in some eating disorders. Moreover, the Wartegg test differentiates the anorexics from the bulimics and the anorexia subtypes.. 114 Pertosa & De Risio

Confirming our hypotheses, the anorexic group presents a higher level of impulsivity. Although this is contrary to many studies (Paul et Al., 2002; Vervaet et Al., 2004), it can be explained through the projective nature of the Wartegg test. Sometimes the significantly restrictive control of impulses is ineffective in anorexics. This would further explain much clinical evidence where restricting anorexic patients show episodic impulsivity. It seems very important in anorexics to effectively control acting and impulses through diet and others very restrictive behaviours. However this strategy does not seem to be efficacious at a more unconscious level, where the defence mechanisms fail. In studies on restricting anorexia Lenihan and Kirk (1990) found high levels of potential impulsivity and acting out using the Hand test, which analogous to the Wartegg test is a projective procedure. From a clinical point of view an impulsive personality trait in restrictive anorexia may find indirect expression in changing therapists, treatment interruptions and compulsive non-compliance, present also in the restrictive anorexia crises (such as emptying nutritional sacs during admissions). This interpretation shows a strong link between controlled eating behaviour and latent or unconscious impulsivity, consistent with the psychodynamic paradigm, that places different eating disorders subtypes in a psychopathological continuum. Moreover this interpretation would explain why projective tests on anorexics seem useful in recognising impulsivity (Lenihan and Kirk, 1990), not identified by questionnaires and interviews (Vervaet et Al., 2004; Paul et Al., 2002). Considering the role that patients’ impulsivity plays in treatment planning, it is important to understand how anorexic patients experience this failure of the control processes. Obviously these failures are not well accepted by anorexic patients owing to their perfectionism, but it is not possible to conclude, given this data, that anorexics are or are not conscious of their impulsivity. There are two possible interpretations. Firstly, considering the urgent need to conform to socially accepted attitudes (perfectionism), this would favour conscious disguising of impulsive drives. On the other hand, the defence mechanism of negation prevents from conscious acknowledgment of impulsive tendencies. In conclusion it would appear that the perfectionism triggers disguising impulsivity or that the defence mechanism of negation prevents the conscious acknowledgment of impulsive behaviour. It is important to evaluate both the presence of impulsive behaviour and the consciousness or unconsciousness of impulsivity in anorexia, in order to plan efficacious treatment and prevent possible threats. References: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Bailer, U., de Zwaan, M., Leisch, F., Strnad, A., Lennkh-Wolfsberg, C., El-Giamal, N., Hornik, K., & Kasper, S. (2004). Guided self-help versus cognitive-behavioral group therapy in the treatment of bulimia nervosa. International Journal of Eating Disorders, 35, 522-537. Bell, R. (1985). Holy anorexia. (Ed.), Chicago: University of Chicago Press. Impulsivity in Eating Disorders 115

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SIS-I and Rorschach in Schizophrenia: A Correlational Study S.Kumar, R.Singh, S.Mohanty and R.Kumar The study was designed to compare the response pattern of SIS-I and Rorschach in schizophrenic patients. The study sample comprised of 30 schizophrenic patients drawn from the inpatients of Institute of Mental Health and Hospital, Agra. 30 normal persons were also included for comparison. SIS-I and Rorschach were administered on each participant. Mean, SD, t-test and correlation were calculated on percent scores of Rorschach and SIS-I. Projective techniques have been used in diverse clinical population for the assessment of perception and psychopathology. Rorschach is the oldest and most widely used projective test in psychiatric set up (Verma and Mishra, 2002). It has been used with varied population such as epilepsy, mental retardation (Somasunderum et.al 1971, Vagrecha and Majumdar, 1975, Upadhyaya and Sinha 1974), children and adolescents (Shanmugam 1969, Asthana and Mohan 1977), psychiatric disorders (Dubey,1982, Mishra and Dwivedi 1997, Kohli and Kaur 2002, Kumar 1960, Kumar, 1965), and prisoners (Sethi et.al 1971, Yadav 1977). The introduction of SIS has renewed interest of researchers in inkblot techniques. The review of literature indicated that SIS–I card form has been used with coronary cases (Rathee et.al 1994), drug addicts (Mukhopadhyay et.al 1996), psychiatric cases (Cassell and Dubey 1998, 2003), schizophrenia (Kumar et.al 2001), and mania (Kumar et.al, 2001, 2003). Study on schizophrenics revealed that they tend to produce low number of total responses; low human responses, low anatomical responses, low most typical responses and low typical responses in comparison to normal subjects. (Dubey et al.1994, Verma et al. 1994). Kaur and Verma (1998) found significant correlation of SIS-II and Rorschach in Most typical, Typical responses, Anatomical responses, Movement responses, Human responses, and Animal responses in a mixed group of psychiatric patients. In schizophrenia significant correlation were found for total number of responses, most typical responses, human responses, animal responses and rejection of images on SIS-II and Rorschach (Rathee et al. 1998). Kumar et.al (2003) observed significant correlation in all the common indices of SIS-I and Rorschach except most typical responses in manic patients. The present study was designed with following objectives: 1. To find out the diagnostic indicators of SIS-I in schizophrenics. 2. To correlate the common indices of SIS-I and Rorschach in schizophrenic patients S.Kumar, R.Singh, S.Mohanty and R.Kumar, Institute of Mental Health and Hospital, Agra Key Word: Schizophrenia, SIS-I, Rorschach, Inkblot techniques SIS J. Proj. Pst. & Ment Health (2006) 13 :120-124

Material and Method: The study sample comprised of 60 participants in two groups schizophrenia (n=30) and normal (n=30). The schizophrenic patients were drawn from the inpatient of Institute of Mental Health and Hospital, Agra. All the patients were diagnosed by the psychiatrists as per ICD-10 diagnostic criteria. The participants of the control group were screened through GHQ-12. (Goldberg,1972). The Sample characteristics are displayed in Table 1. Table 1 Sample Characteristics Normal Schizophrenics (n=30) (n=30) Age: (Mean±S.D) 35.10±10.13 34.47±7.22 Education 0-5 10.00% 30.00% 6-9 23.33% 13.33% 10+ 66.66% 56.60% Occupation Nil 13.33% 16.66% Service 26.66% 23.33% Business 6.66% 30.00% Labor/Agriculture 53.33% 30.00% Domicile Rural 33.33% 50.00% Urban 66.60% 50.00% Marital Status Married 73.33% 63.33% Unmarried 26.66% 36.66% Family Type Nuclear 60.00% 40.00% Joint 40.00% 60.00% Duration of Illness (in years) 8.40±5.21 months Rorschach and SIS-I were administered on each participant. The scoring of Rorschach protocol was done according to Beck’s method. Raw scores on Rorschach and SIS-I indices were converted into percentages. Mean, SD, t-test, and product moment correlation were calculated. Result and Discussion: The mean, SD and t-values of SIS-I indices are presented in Table 2. The schizophrenic patients have significantly low scores on total number of responses, anatomical responses, movement responses, and typical responses as compared to normal subjects. The schizophrenics scored significantly higher on human and atypical responses. In another study, significant differences were found between schizophrenics and normal on total number of responses, movement responses, animal responses, anatomical responses, rejection of images, most typical responses, and typical responses (Srivastava, 2002) SIS-I & Rorschach in Schizophrenia 121

Table 2 Mean, S.D. and t-values of Schizophrenics and Normal on SIS-I Indices Indices Groups Mean Standard Deviation t-values Total number Schizophrenia 19.83 4.37 3.91* of responses Normal 25.26 6.21 Human responses Schizophrenia 37.30 30.19 4.34* Normal 12.52 8.07 Animal responses Schizophrenia 26.44 21.83 .63 Normal 29.13 8.53 Anatomy responses Schizophrenia 15.61 21.67 2.20** Normal 25.98 13.89 Sex responses Schizophrenia 03.10 9.12 1.19 Normal 01.05 2.44 Rejection of Images Schizophrenia 21.44 24.63 2.00** Normal 11.56 11.07 Movement responses Schizophrenia 01.01 3.16 3.07* Normal 03.96 4.19 Most typical responses Schizophrenia 06.95 4.68 .84 Normal 08.53 5.43 Typical responses Schizophrenia 41.34 15.77 7.88* Normal 68.26 10.02 Atypical responses Schizophrenia 52.02 20.50 6.70* Normal 23.15 11.67 * Significant at .01 level; **significant at .05 level Mean and SD of Rorschach indices are presented in Table 3: Table 3 Mean and S.D. of Schizophrenics on Rorschach Test Indices Mean S.D. Total number of responses 11.73 3.10 Movement 5.04 2.68 Rejection of Images 11.22 9.02 Sex 4.33 1.24 Human 6.87 2.89 Anatomical 17.83 4.28 Good Forms 26.57 5.89 Animal 33.61 14.99 Popular 11.47 5.88 Whole 32.26 14.24 Obvious Detail 54.37 24.70 Rare Detail 12.93 4.67 Colour 4.68 .97 Shading 2.67 .48 122 Kumar et al

The correlation co-efficient between common indices of SIS-I and Rorschach are presented in Table 4. Table 4 Correlation Coefficient in Common Indices Indices Value of Correlation Significance Level Total Responses 0.36 .05 Human Responses 0.29 n.s Anatomy Responses 0.21 n.s Most Typical Responses 0.01 .01 Rejection of Images 0.56 .01 Typical Responses 0.26 n.s Movement Responses 0.02 n.s Sex Responses 0.83 .01 Table 4 reveals significant and positive correlation between SIS-I and Rorschach scores on total number of responses, rejection of images, most typical responses, and sex responses. Kaur and Verma (1998), Rathee et al, (1998) and Kumar et al (2003) also observed significant and positive correlations between SIS and Rorschach in various populations. Conclusion: The SIS-I is a powerful tool in discriminating schizophrenics and normal subjects. There are significant and positive correlations between SIS-I and Rorschach in Schizophrenics. References: Asthana,H.S. and Mohan,C. (1977) Perceptual development in Indian child: A Rorschach study, Unpublished Report, Sagar University, Sagar Cassell, W.A. and Dubey, B.L. (1998) Application of somatic inkblot series in personality assessment, diagnosis, screening and therapy. SIS Journal of Projective Psychology and Mental Health, 5, 3-32 Cassell,W.A and Dubey,B.L (2003) Interpreting inner world through somatic imagery: Manual of somatic inkblot series. SIS Centre, Anchorage: Alaska Dubey,B.L.(1982) Pragmatic View of Rorschach Test. National Psychological Corporation, Agra Dubey, B.L. Mishra, M. Dwivedi, C.B. and Mishra, N.(1994). Diagnostic and therapeutic utility of somatic inkblot series-II and Rorschach. SIS Journal of Projective Psychology and Mental Health, 1, 19-26. 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 and Mental Health, 5, 115-118. Kohli,A. and Kaur, R.P. (2002) Rorschach profile and its relationship with PEN questionnaire in borderline psychosis. SIS Journal of Projective Psychology and Mental Health, 9, 109- SIS-I & Rorschach in Schizophrenia 123

Kumar, P. (1960). The Rorschach test in manic and normal group. Indian Journal of Psychology, 35, 35-38. Kumar, P. (1965). The Rorschach test in some mental disorders : manic group. India Journal of Psychology, 40, 13-17. Kumar, S. Singh, R. and Mohanty, S. (2001). A study as Somatic Inkblot Series-I in hospitalized male chronic schizophrenic. SIS Journal of Projective Psychology and Mental Health,8, 31-37. Kumar, S. Mohanty, S. and Kumar, R. (2003). SIS-I profile and its correlation with Rorschach in manic patients. SIS Journal of Projective Psychology and Mental Health, 10,. Mishra, M., and Dwivedi, C.B. (1997). Content scale based diagnostic compatibility of SIS-II with Rorschach Test in normals, neurotics and schizophrenics. SIS Journal of Projective Psychology and Mental Health, 4, Mukhopadhyay, A. Benerjee, S. and Mitra, G.( 1996). A comprehensive profile of personality characteristics of male drug addicts. SIS Journal of Projective Psychology and Mental Health, 3, 33-41. Rathee, S.P. Goel, D.S. Chawla, M.L. Saldanha, D. and Dubey, B.L. (1994). A study of SIS-I in coronary cases. SIS Journal of Projective Psychology and Mental Health, 1, 51-64. Rathee, S.P., Sarkar, P., and Singh, A. (1998) Diagnostic validity of SIS-II among psychopathological cases of armed forces, 5, 139-144. Sethi, B.B., Gupta, S.C., Raj, A.S. and Nathawat, S.S.(1971) Rorschach as a measure of psychopathology in murderer. Indian Journal of Psychiatry, 13, 243-247. Shanmugam, A.V. (1969) A Rorschach study of stars and isolates among high school students. Psychological Studies, 4, 35-49. Somasunderum, C.P., Mathai, K.V., and Jesudian, G. (1971) The application of the Rorschach technique in patients disabled by convulsive disorders. Neurology India, 19, 64-72. Upadhyaya, S. and Sinha, A.K. (1974) Some findings on psychodiagnostics tests with young retarded adults. Indian Journal of Clinical Psychology, 1, 73-79. Verma, S.K., Pershad, D., and Nehra, R. (1994). Cross- validation of SIS-II in psychiatric population. SIS Journal of Projective Psychology and Mental Health, 1, 15-18. Verma, M.K. and Mishra, S. (2002) Rorschach response patterns of drug addicts. SIS Journal of Projective Psychology and Mental Health, 9, 62-64. Vagrecha, Y.S. and Majumdar, D.P.S.(1975) diagnostic value of Piotrowski signs in Rorschach responses in epileptic patients. British Journal of Projective Psychology and Personality Studies, 20, 27-32. Yadav, A.R. (1977). Rorschach responses of the institutionalized offenders. Indian Journal of Clinical Psychology, 4, 151-156. 124 Kumar et al

Psychoanalytic Conceptions of the Mind in Relation to Personality Disorders of Drug Abusers Kristian Aleman The purpose was to investigate whether signs of DMTm (Defense Mechanism Technique modified) could discriminate between the ten groups of DSM-III-R personality disorders (PDs) and DSM- III-R clusters among drug abusers. DMTm signs are interpreted as different kinds of defense and anxiety. The 65 subjects were recruited from Sabbatsberg Hospital, Sweden. Prominent affect defenses were projected introaggression in paranoid and schizotypal PDs, introaggression in borderlines, inhibition in avoidant PD and barrier/affect isolation in obsessive-compulsive PD. Prominent identity defenses were marked denial in narcissism, reversal II 1–2 in dependent PD and reversal IV in histrionics. Patients with anti-social PD (ASPD, n= 53 out of 65) were analyzed separately. Results underlined psychoanalytic conceptions of the mind in relation to PDs of drug abusers. Defense Mechanism Technique modified (DMTm) is a percept-genetic technique of personality assessment, especially focused on defense mechanisms, constructed by Andersson (1991). DMTm signs (i.e. signs of Defense Mechanism Technique modified) are interpreted to reveal defense mechanisms and in addition different kinds of anxiety. What is named “additional” sign is interpreted as signs of neither defense nor anxiety. DMTm has been developed from the original Defense Mechanism Test (DMT) that was invented by Kragh (1969, 1985) primarily as a test for personnel recruitment. In a sequence of investigations, Aleman (2004) first investigated how 19 drug abusers with psychosis (DSM-III-R) differed in DMTm in comparison to 65 non-psychotic drug abusers. Among all results, the psychotic drug abusers were more prone to score: traumatic anxiety, repression, denial 2–3, splitting, reference and three out of the four variants of identity defense, i.e. denial through reversal. To sum up, the psychotics showed signs in DMTm of anxiety, an “additional” sign and almost all identity defenses; only one affect defense was noted. In a second study with the focus on the 65 non-psychotic drug abusers, Aleman (2005) investigated whether DMTm signs related especially to DSM-III-R clusters, but also to the different PDs, independently of cluster. The three largest groups of PDs turned out to be paranoid, narcissistic and borderline disorders. Results showed that projected introaggression was significant to cluster A (“odd”) and inhibition to cluster C (“fearful”). Results directed to PDs were: barrier isolation and introaggression were significant to borderline PD while narcissistic drug abusers significantly showed no introaggression. Borderlines showed the “additional” sign of disappearance of threat as well. A later problem emerged: how could DMTm results be understood in relation to DSM- III-R clusters that are heterogeneous in character? Specifically, clusters B (“dramatic”) Kristian Aleman, Department of Psychology, Lund University, Vidargatan 5, entréplanet, 113 27 Stockholm, SWEDEN, kristian.aleman@ka-psychoanalysis.se, telephone: + 46 8 32 82 08 Key Word : DMTm, drug abuse, PD (personality disorder), ASPD (anti-social PD), clusters SIS J. Proj. Pst. & Ment Health (2006) 13 :125-138

and C (“fearful”) were estimated to be diverse, while cluster A (“odd”) was more homogeneous and additionally more influenced by heredity than the other clusters. It was also unfortunate that only three out of ten groups of PDs could be statistically calculated. These problems were challenges for a third investigation. The present investigation, the third in sequence, was triggered by the above-mentioned second study (Aleman, 2005). From perspective of the second study—that only three out of ten groups of PDs could be statistically analyzed and that another dilemma was exposed, namely, difficulties in understanding DMTm results in relation to DSM-III-R clusters—a complementary approach was used. The following research question was raised: “Would it be possible to understand the constitution of these clusters better if the present DMTm investigation more specifically used all ten independent DSM-III-R PDs included in the clusters?” The problem of this hypothesis was, as in the second study, the risk of mass significance because of many comparisons of groups of PDs with few subjects. The purpose of this study was therefore to investigate whether DMTm signs could be meaningfully distributed (without statistical calculation) in some of the ten groups of PDs. In this manner of procedure, the results of this study may contribute to understanding drug abusers investigated for DMTm in relation to DSM-III-R clusters and PDs. Another purpose was to investigate the 53 drug abusers diagnosed with ASPD with comorbidity of a second PD in relation to DMTm. The final purpose was to compare results with some empirical studies of projective techniques, DMTm, DMT, MCT (Meta Contrast Technique, Smith, Johnson & Almgren, 1989) and CFT (Creative Functioning Technique, Smith & Carlsson, 1990), but less rigorously compared to the study by Aleman (2005). Method: Subjects: The 65 drug abusers were consecutively recruited during the years 1994–96 from the drug abuse clinic at Sabbatsberg Hospital in Stockholm, Sweden. They were specifically recruited from a motivation unit for non-psychotic drug abusers. They had in common the DSM-III-R, axis I, diagnosis of substance dependence on either heroin (11 women and 25 men) or amphetamine (8 women and 21 men) for at least five years. All patients used large doses of the drug daily, although some had abused alcohol, cocaine or bensodiazepines for periods of time. There was a balanced frequency between the two different drug groups, although not of relevance for investigation in this study. Exclusion criteria were diagnoses of affective uni-/bipolar mood disorder, organic brain damage and long-term psychopharmacologic therapy. In the group of 65 drug abusers the median age was 31.5 years and the age range was 22–43 years. At the time of testing with DMTm, all of them had been drug-free for at least four weeks,1 and DSM-III-R diagnoses were assessed shortly after this test. Five psychiatrists were trained in applying DSM-III-R, axis II, concerning diagnoses of PDs of the 65 drug abusers. SCID II, The (semi-) Structured Clinical Interview for DSM-III-R was used to 126 Kristian

confirm a suspected DSM-III-R diagnosis. SCID was not used as an intake procedure, insuring that all of the major axis II diagnoses were systematically evaluated. A control that no one of the five psychiatrists had an excess tendency to diagnose a particular PD, because of “a favorite diagnosis,” was performed and showed this was not the case. The patients, irrespective of drug of choice, were distributed in three DSM-III-R conceptualized clusters depending on the PDs. No overweight of either a specific drug, deviation of age or sex was seen in the three clusters. Cluster A (n= 15), called “odd” or “eccentric,” consisted of the following PDs: paranoid (n= 8), schizotypal (n= 3), schizoid (n= 4). Cluster B (n= 22), called “dramatic,” consisted of: borderline (n= 8), histrionic (n= 5) and narcissistic (n= 9) PDs, while cluster C (n= 22), called “fearful” or “anxious,” consisted of avoidant (n= 6), dependent (n= 7), obsessive-compulsive (n= 6) and passive-aggressive (n= 3) disorders. The number of patients with diagnosis of UNS (unspecified, or combinations of different PDs with no apparent dominant one) was 6. Note that the DSM-III-R criteria for ASPD, normally in cluster B, were fulfilled by 53 patients out of 65. The subjects in this study were heavy intravenous drug abusers, involving a high degree of criminality. In Tables 1 and 2, ASPD was seen not as a primarily PD, but a very common trait among heavy drug abusers. On the other hand it seemed important to observe the 53 drug abusers as primary ASPD with comorbidity of a second PD, i.e. another axis II diagnosis (see Figure 1). DMTm signs in ASPD together with their second PD were also presented (see Table 3). A critical aspect of representation of the 65 drug abusers was the dilemma that drug abusers who were excluded in the consecutive series of patients were not registered. Specific information on how many of the excluded drug abusers could be diagnosed with affective uni-/bipolar mood disorders, brain damage etc. was thus not documented. Defense Mechanism Technique Modified: DMTm is designed to facilitate interpretation of results in terms of the Andersson (1991, 2004) psychoanalytic model of the mind. An important aspect of this model is that main motives and even specified motives for defense can be derived from developmental positions. Andersson describes two basic types of defenses: affect and identity defenses. Affect defenses are: repression, projected introaggression, inhibition, introaggression, barrier isolation and affect isolation. The main motive behind affect defense (position 4) is “intrapsychic threat,” e.g. distorted oedipal fantasies, evoked by affect anxiety. The second type of defense, identity defenses are: denial and denial through reversal I–IV. The main motive behind denial (position 2) is “loss of the security-providing object” evoked by separation anxiety and the main motive behind denial through reversal (position 6) is “loss of sense of self” evoked by identity anxiety. The specified motives behind defenses can be obtained from different psychoanalytic models. The specified motive behind denial derives from Freud’s (1900) reflex-arc (attachment) model (cf. Bowlby, 1979). The specified motives behind denial through reversal I–IV from Kohut’s (1971, 1977, 1984) model of self/self-object. The specified motives behind affect defenses from Klein’s (1935, 1940, 1946) affect positions model. Personality Disorders of Drug Abusers 127

Two different picture-motifs are shown in a tachistoscope. The first one motif and then the other is shown in a series of 20 expositions each, the exposition time increasing successively in each series from 5 to 1150 milliseconds. After each exposition, the subject’s task is to report verbally what has been seen or experienced, and at the same time drawing a simple picture. This results in a total of 40 such reports, 20 for each picture-motif. At the center of both pictures, a young person of the same sex as the test person can be seen. This person, termed the hero or heroine (H), is also provided with a disguised sexual attribute (A). Shown in a peripheral position in the picture is an older person of threatening appearance, who in the first picture is a woman (“the threatening mother”) and in the second picture a man (“the threatening father”), termed in both cases the Pp (peripheral person). When the test person deviates from “correct” reporting of the content of the pictures, it is of primary essence. Some deviations are interpreted as signs of defense and others as signs of anxiety. Still other deviations, referred to in the manual (Andersson, 2004) as “additional” signs, are interpreted as signs neither of defense nor of anxiety. It is primarily within this category that “new” signs, such as that referred to here as “disappearance of threat,” have been explored in this investigation and in others. The DMTm protocols obtained were blind-coded by Professor A. L. Andersson and by the author of this paper. In those few cases where our codings failed to coincide, we reached agreement. Then the start of data distribution, in form of a straightforward listing of DMTm signs, was processed (see Tables 1, 2 and 3). To minimize the frequency of variables, DMTm was used exploratory. One can find DMTm signs in either series 1 alone, in series 2 alone or in both series 1 and 2. This procedure resulted in 21 dichotomous variables, with at least five individuals/signs each. That number in each variable was assumed to be the minimum to be presented in the tables of results. These signs were involved: affect anxiety; identity anxiety; H- repression, Bp-repression; projected introaggression; inhibition; introaggression; barrier isolation; affect isolation; marked denial; denial 2–3; denial through reversal I, II 1–2, II 3, III and IV; disappearance of A; disappearance of threat; H positive; H afraid and Bp wrong gender. The content of different DMTm signs reported in tables of results is described here: Affect defenses: Projected introaggression. Pp being seen as injured, tormented, dejected, sad, frightened, worried or exposed, or A being seen as something which is damaged, broken, worthless, bad or threatening. Inhibition. On at least five consecutive exposures, Pp being seen as a petrified, inanimate or disguised being that is neither threatening nor unpleasant, or as a specified object (repression at the place of Pp not scored here), or on at least five consecutive exposures, Pp being seen as an object distinguished by its contour or as a framed, empty surface (barrier isolation not scored here). Introaggression. H being seen as injured, wretched, in trouble, or the like, or as being critical toward the self or involved in a situation of destructive character. 128 Kristian

Barrier isolation (1–2). A barrier being added between H and Pp or H and Pp belonging to different realities, or Pp being seen as a framed, empty surface or as an object distinguished by its contour. Affect isolation (3–4). Pp being seen as a white or shining object or surface, or there being a total loss of the specified content in the exposure preceding the loss. Identity defenses: Marked denial. Pp being missing or uninterpreted on at least seven consecutive exposures, starting with the first exposure (denial 1) and additionally 4 exposures in either of the series 1 or 2 (marked denial). Denial through reversal II 1–2. H and Pp being seen as having a positive relationship on any of the exposures or Pp as being positive in character on at least two exposures, H is angry or threatful while Pp is neither threatful nor unsympathetic. Denial through reversal IV. Pp being doubled, or H being seen as a duplicate of H, or Pp’s gender being changed from correct to incorrect but Pp being neither threatening nor unpleasant when thus changed, or Pp being explicitly denoted as H’s father in the first series or as H’s mother in the second series and at the same time being neither threatening nor unpleasant, or Pp being a person younger than H and being neither threatening nor unpleasant, or H being changed from a younger person to an older one 35 years of age or more, or H being seen as an older person, 35 years or more, on at least 12 consecutive exposures. “Additional” sign: Disappearance of threat. Denotation of threat being missing on Pp on at least two consecutive exposures after an earlier indication. Data Analysis: Bold results in Tables 1, 2 and 3 were statistically significant with a p-value of between .01 and at least .0002 when calculated with Fisher’s exact probability test. This statistical test is appropriate to use when calculating fourfold tables where numbers in any cell are low, as in this study. To calculate fourfold table, one PD was compared to the rest of the nine PDs (that constituted one group) in relation to a DMTm sign (how many subjects had/had not the sign in question). Such repeated pair wise comparisons would create mass significance when these calculations were multiple (each PD must be compared to the rest of the nine PDs, as a group, in relation to 21 DMTm variables). Chi-square was also inappropriate to use when numbers in cells became as low as between 3 and 9. In this study, instead a straightforward listing of DMTm signs in relation to ten groups of PDs seemed to be more adequate. This approach was warranted since the purpose of the study was to reveal novel and possibly meaningful DMTm signs and patterns. Bold numbers in Tables 1, 2 and 3 indicate prominent DMTm signs. Personality Disorders of Drug Abusers 129

Results: Five affect defenses were found in drug abusers with different PDs (Table 1). In the “odd” cluster, both paranoid and schizotypal PDs showed projected introaggression. In the “dramatic” cluster, borderlines showed (8/0) more introaggression than other PDs did, while narcissistic PD in the same cluster proved a diametrically opposite result, no introaggression at all (0/9). Drug abusers with avoidant PD in the “fearful” cluster showed a high frequency of inhibition. Obsessive-compulsive PD in the same cluster confirmed a high occurrence of both barrier and affect isolation. Three identity defenses were prominent in drug abusers with narcissistic, histrionic and dependent PDs (Table 2). In the “dramatic” cluster, narcissism showed marked denial (8/1) and histrionics, denial through reversal IV (reversal). Drug abusers diagnosed with dependent PD, in the “fearful” cluster, showed reversal II 1–2. Two identity defenses and one affect defense were common in ASPD with comorbidity of another DSM-III-R, axis II diagnosis (Table 3). These results were chronologically: ASPD/narcissism confirmed a high occurrence of marked denial and ASPD/dependent confirmed reversal II 1–2. ASPD/borderlines showed the affect defense of introaggression. The only frequent “additional” sign was disappearance of threat. It was related to drug abusers diagnosed as borderline PD (Table 2) and also in ASPD/borderline (Table 3). No DMTm sign of different kinds of anxiety was found. Table 1 Affect Defenses in Relation to Personality Disorders of Drug Abusers DSM-III-R Projected Intro- Inhibition Barrier Affect clusters introaggression aggression isolation isolation “Odd” Paranoid (n= 8) 4/4 3/5 0/8 3/5 1/7 Schizotypal (n= 3) 3/0 2/1 1/2 1/2 Schizoid (n= 4) 0/4 1/3 0/4 1/3 0/4 “Dramatic” Borderline (n= 8) 1/7 8/0 0/8 5/3 2/6 Histrionic (n= 5) 1/4 1/4 0/5 0/5 1/4 Narcissistic (n= 9) 0/9 0/9 0/9 0/9 0/9 “Fearful” Avoidant (n= 6) 0/6 0/6 4/2 1/5 2/4 Dependent (n= 7) 3/4 3/4 0/7 2/5 0/7 Obsess.-comp. (n= 6) 1/5 3/3 1/5 6/0 4/2 Passive-aggr. (n= 3) 1/2 3/0 0/3 1/2 1/2 UNS (n= 6) 0/6 1/5 0/6 0/6 1/5 Note, the first number in the distribution indicates the frequency of patients who have the sign in question, the second number shows the frequency of patients who lack the sign. 130 Kristian

Table 2 Identity Defenses and One “Additional” Sign in Personality Disorders of Drug Abusers DSM-III-R Marked Reversal Reversal IV Disappearance clusters denial II 1–2 of threat “Odd” Paranoid (n= 8) 1/7 2/6 3/5 3/5 Schizotypal (n= 3) 2/1 1/2 2/1 0/3 Schizoid (n= 4) 2/2 0/4 1/3 0/4 “Dramatic” Borderline (n= 8) 3/5 3/5 2/6 5/3 Histrionic (n= 5) 1/4 3/2 5/0 1/4 Narcissistic (n= 9) 8/1 1/8 4/5 0/9 “Fearful” Avoidant (n= 6) 1/5 0/6 1/5 0/6 Dependent (n= 3) 1/6 6/1 3/4 3/4 Obsess.-comp. (n= 6) 2/4 0/6 1/5 1/5 Passive-aggr. (n= 7) 2/1 2/1 0/3 1/2 UNS (n= 6) 0/6 1/5 0/6 0/6 1/5 Table 3 DMTm Signs in Drug Abusers With ASPD and Co-morbidity of Another DSM-III-R, Axis II Diagnosis DSM-III-R Marked Reversal Reversal IV Disappearance clusters denial II 1–2 of threat “Odd” ASPD/Paranoid (n= 3) 0/3 1/2 0/3 1/2 ASPD/Schizotypal (n= 2) 2/0 0/2 0/2 1/1 ASPD/Schizoid (n= 3) 2/1 0/3 0/3 1/2 “Dramatic” ASPD/Borderline (n= 8) 3/5 3/5 5/3 8/0 ASPD/Histrionic (n= 4) 1/3 2/2 1/3 0/4 ASPD/Narcissistic (n= 9) 8/1 1/8 0/9 0/9 “Fearful” ASPD/Avoidant (n= 5) 1/4 0/5 0/5 0/5 ASPD/Dependent (n= 7) 1/6 6/1 3/4 3/4 ASPD/Obsessive-comp. (n= 3) 1/2 0/3 0/3 1/2 ASPD/Passive-aggressive (n= 3) 2/1 2/1 1/2 3/0 ASPD/UNS (n= 6) 4/2 1/5 1/5 1/5 Attrition: 12 out of the 65 drug abusers did not fulfill the criteria of anti-social PD (ASPD, n= 53). Personality Disorders of Drug Abusers 131

Figure 1. A second DSM-III-R, axis II diagnosis in drug abusers with primary anti-social PD (ASPD). The proportion of comorbidity in ASPD showed that PDs from the “dramatic” cluster were the most prevalent second diagnosis, especially narcissism (n= 9) and borderline (n= 8). Discussion: Projected introaggression was considerably more prominent in drug abusers with paranoid and schizotypal PDs (cluster A) than the other groups of PDs. This is useful and complementary to the previous study (Aleman, 2005) that showed statistically significant (p= .03) projected introaggression to cluster A (“odd”), but could not specify which PDs were related to the DMTm sign in question. Schizoid PD, also in cluster A, was the only one that did not contribute to the result. The main motive behind affect defenses derives from position 4, “intrapsychic threat” evoked by “affect anxiety,” in the Andersson psychoanalytic model of the mind. The specified motive behind projected introaggression can be interpreted as an expression of problems in the paranoid-schizoid position (Klein, 1946), position 1 in the model. The individual has to handle something “unconditionally evil.” There is a function to project self-destructive components in anything or anybody outside the central self, which creates a persecutory inner world. This is a deficiency in the personality organization to “contain the evil inside.” In a study (Bergman, Bergman, Dahlgren & Åsberg, 1992) using DMT, significantly more signs of projected introaggression (also introaggression) were discovered in women with alcohol abuse and in women with depression than a control group. In another DMT study, Sundbom (1992) found a higher frequency of projected introaggression in psychotic inpatients than in neurotics and borderlines. An earlier investigation (Aleman, 2004) of psychotic drug abusers did not demonstrate any projected introaggression. Sundbom’s result is nevertheless of interest for the present study. Diagnoses of paranoid and schizotypal (even schizoid) PDs can also be called “spectrum diagnoses,” i.e. not far from being diagnosed as (pre-)psychotic. That is not the case with other PDs. There 132 Kristian

is considerable evidence for genetic contributions to paranoid, schizotypal and schizoid PDs. This means that they have an inherited tendency to the peculiarities of cognition and eccentricities of thought, which is typical of schizophrenia (e.g. Kety, Rosenthal, Wender, Schulsinger & Jacobsen 1975; Siever, Klar & Coccaro, 1985; Siever, Bernstein & Silverman, 1989). Cluster A seems to be more influenced by heredity and is more homogeneous than the other clusters (cf. Fridell, 1996). Drug abusers diagnosed as borderline, in cluster B, showed drastically (8/0) more introaggression than all the others. In the previous study (Aleman, 2005) borderlines significantly (p= .0002) showed introaggression. Interestingly, introaggression could be seen as a differential DMTm sign between borderlines compared to those with narcissistic and avoidant PDs who did not have introaggression at all. Borderline and narcissism, from the same “dramatic” cluster, showed a totally opposite defensive organization here. According to the present study it is possible to conclude that cluster B is the most heterogeneous cluster of all three investigated from the perspective of DMTm. Even other data from a 5- and 15-year follow-up study (Fridell, Hesse & Johnsson, 2005) showed that ASPD distinctly had worse outcome in criminality, continuous drug abuse and higher mortality compared to patients with other PDs. In DMTm, the specified motive behind introaggression derives from position 2, the depressive position (Klein, 1935, 1940) in which the infant widens psychologically, unfolding from part objects to whole objects. It perceives more realistic experiences in the (whole) relation. This creates inner tension and the child can suddenly feel ambivalent feelings about the loved object. The love and hate are now directed toward the same whole object and it is difficult to protect the loved parent from its hate. This condition mobilizes feelings of guilt. An unhealthy variant is to direct this hate toward the self (introaggression) to protect the parent. Sundbom (1992) observed discriminative DMT signs between neurotic, borderline and psychotic patients. Principal component analysis showed that borderlines correlated to introaggression significantly more than neurotics and psychotics. The DMTm sign of inhibition (position 2) proved to be more common in avoidant drug abusers than in the others. This sign was the least frequent among all signs, only six individuals/signs, but four of them in avoidant drug abusers. In the study by Aleman (2005), the result showed significance (p= .04) between inhibition and the whole group of cluster C. From the present study, it is possible to deduct that avoidant PD crucially contributed to the significant result in relation to the whole cluster. As one empirical example of inhibition, Andersson and Ryhammar (1998) were investigating 132 university teachers according to DMTm and CFT. Among all the results they found inhibition (and affect isolation) in those teachers who were not creative at all in CFT. Drug abusers with obsessive-compulsive PD showed more of barrier and affect isolation than other PDs. Borderline was the only one that came close (5/3) to this result. In fact, Personality Disorders of Drug Abusers 133

in the study by Aleman (2005) previously referred to, borderline correlated significantly (p= .03) to barrier isolation in a statistical analysis (Fisher’s exact probability test). Barrier isolation derives from position 2 (see above) while the specified motive of affect isolation derives from position 3 in the Andersson psychoanalytic model. This position, manic-obsessional position (cf. Klein, 1935, 1940), corresponds to position 1 in the model. It engages the unconditional evil inside. The prototype state of mind here is a paranoid and schizoid world. In position 1, the typical way in percept-genetic symbolization to handle this evil could be described as “reification,” connected to repression, while in position 3 it is more about “annihilation” (connected to affect isolation) of the evil. Klein clearly pointed out that annihilating the evil affects induced the risk of also annihilating the good affects leading to a psychic vacuum. Smith, Johnson and Almgren (1989) assumed that a specific type of “whitening” the content (as one expression of affect isolation in DMTm) of the exposure in MCT has specifically to do with regressive strategies. It constitutes a discontinuity. Kragh (1985) empirically confirmed association between the category of isolation in DMT and obsessive-compulsive PD. This result has been corroborated by other studies (cf. Von der Lippe & Torgersen, 1984). Bergman et al. (1992) had critically more of isolation in women with ethanol abuse who succeeded worst in treatment. Montgomery (2002) investigated 128 heavy drug abusers using DMTm, where affect isolation was one of the significant results. It was typical of 29 females using heroin, together with 31 males using amphetamine. The identity defenses were meaningfully spread among three different PDs. Marked denial was frequent in narcissistic drug abusers in comparison to other PDs. According to the Andersson (1991, 1998) psychoanalytic model of the mind, the main motive (position 2) behind denial is “loss of the security-providing self-object,” evoked by separation anxiety. The specified motive derives from position 1 and deals with feeling of loss with a sense of abandonment caused by loss of a primary object (Bowlby, 1979). Andersson believes that this is an effort to embrace the self-integral when exposed to external threat. Marked denial is an elaboration of denial 1, more intense denial. This DMTm sign was not explored in the previous study by Aleman in 2005. There seems to be an important difference between narcissistic PD and psychotic drug abusers in handling abandonment. The former group showed marked denial (no perception of Bp at all, first 7 exposures plus 4 more exposures in any of the two series), while the latter group instead handled denial 2–3 (discontinuity in perception of Bp). Despite that, Aleman (2004) postulated that the psychotics dealt with the same psychological predicament, in the same position of the model, as the narcissistic drug abusers in this study. It is interesting that drug abusers diagnosed as dependent (on others) “must” perceive the relation between Pp and H as very positive, reversal II 1 (reaction formation), although the content of the objective picture-motif is the opposite. It is of course critical whom one is vulnerable to and dependent on when “loss of sense of self” is mobilized, which is the main motive (position 6) for the identity defenses of reversal I–IV in the Andersson psychoanalytic model. This process is deepened from the aspect of the specified motive in position 3 (early) of the oedipal period, behind reversal II 1–2, where “loss of the idealized self-object” comprises a threat to identity. In this developmental position of the model there is a critical dilemma to be separate and 134 Kristian

different from the other. In the variant of reversal II 2 (H is angry or threatful while Pp neither is threatful nor unsympathetic), one can argue that dependent drug abusers rather place aggression within themselves (H) than in Pp. This could be seen as one strategy to “conserve” the idealized parent. Empirically, this sign of reversal II 1 (reaction formation) becomes frequent in both normal population and in clinical groups (e.g. Sjöbäck, 1972). Some studies with use of DMT show a higher degree of the sign in question in clinical groups than in normal population (Rubino, Pezzarossa & Ciani, 1991; Bergman et al., 1992). Reversal IV was more common in histrionic drug abusers compared to all others. For the first time in the results (see Tables 1 and 2) the group of UNS also had a relatively high frequency (5/1) of the sign in question. The specified motive here derives from position 4 in the Andersson model and deals with “loss of the grandiose self,” while having difficulties with the emotional barrier in the oedipal period concerned with the generation gap. This triadic drama threatens the sense of self. One study (Bogren, Bogren, Orth & Sjödin, 2002) showed that reversal IV was relevant when patients diagnosed as having panic disorder and agoraphobia scored high points on BDI (Beck Depression Inventory). Finally, in a study (Aleman, 2004) of differences in DMTm between psychotic and non-psychotic drug abusers, psychotics symbolized difficulties with the barrier of generation, which is operationalized through reversal IV. The “additional” sign of disappearance of threat is still under empirical evaluation and does not yet have a position in the Andersson model. This sign was prominent in borderlines (Table 2). In a study (Aleman, 2005), disappearance of threat showed statistical significance (p= .01) in drug abusers with borderline PD. The DMTm sign was also compared to other empirical investigations and theoretically discussed in that paper. Now attention should be focused on the large group of ASPD, which consisted of 53 drug abusers. The most frequent DMTm signs for the total group of ASPD, i.e. including all ten second PDs (see Figure 1), were: denial 1 (n= 43), H-repression (n= 36) and reversal IV (n= 23), but they did not differ from the 12 drug abusers without diagnosis of ASPD. Prominent DMTm results in relation to ASPD with comorbidity of another axis II diagnosis were presented. From the perspective of DMTm, it is interesting that introaggression, “self-destructiveness,” was the only predominant affect defense in the group of ASPD in combination with borderline. All 8 borderline patients were included in the group of ASPD, which means that the “additional” sign, disappearance of threat, remained common as well. These two DMTm signs are specifically related to severe problems with aggression. It is equally interesting that marked denial, against “loss of the security-providing selfobject,” also was indicative in relation to ASPD, which included all 9 narcissistic drug abusers; all but one scored the sign in question. It is worth mentioning that, if one goes back to Figure 1 and observes the proportion of a second diagnosis in the large group Personality Disorders of Drug Abusers 135

of ASPD, borderline and narcissism, from the ”dramatic” cluster, were especially prevalent in the group of ASPD (cf. Fridell, Hesse & Johnsson, 2005). The DMTm sign of reversal II 1–2 was prominent in the seven drug abusers with dependent PD. All of them were included in the group of ASPD. In sum, there seems to be an interesting and meaningful distribution of DMTm signs in almost all ten groups of PDs (all but schizoid and passive-aggressive PDs). Drug abusers, in the present study, used virtually all categories of DMTm signs (not DMTm signs of different kinds of anxiety). This study has increased the psychodynamic knowledge of drug abusers with PDs and also in relation to the diverse classification of DSM-III-R clusters. The results of the present study have been complementary to those in the previous published paper by Aleman (2005). They have specified the overall results between DMTm signs and DSM-III-R clusters and also expanded the number of PDs to be explored. The results of this present study located the specific PDs that contributed to statistically significant DMTm results in relation to DSM-III-R clusters (cf. Aleman, 2005). Furthermore, an analysis of the results were able to show that affect defenses are more prominent in clusters A and C, definitely least in cluster B, while identity defenses and one “additional” sign proved to be most frequent in cluster B. It seems not to be a random effect that cluster A (“odd”), characterized by projected introaggression, was the only one of all results that was scored by two different PDs (paranoid and schizotypal) in the same cluster. This cluster is known to be the most homogeneous and related to heredity. DMTm has also been useful for a descriptive analysis of drug abusers diagnosed with both ASPD and another DSM-III-R, axis II diagnosis. One affect defense, two identity defenses and one “additional” sign were characteristically prominent. The straightforward listing of DMTm signs provided material for exploring psychoanalytic conceptions of the mind in relation to PDs of drug abusers. The results were interpreted from the psychoanalytic model of the mind that Andersson (1991) has created. In the future we may hope that this psychodynamic view will contribute to the planning of treatment for drug abusers with PDs. References: Aleman, K. (2004). Differences in terms of the Defense Mechanism Technique modified (DMTm) between psychotic and non-psychotic drug abusers. J. Proj. Psy. & Ment. Health, 11, No 1: 25–35. Aleman, K. (2005). Defense Mechanism Technique modified (DMTm), DSM-III-R clusters and personality disorders in drug abusers. J. Proj. Psy. & Ment. Health, 12, No 1: 9–19. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington DC: Author. Andersson, A. L. (1991). Perceptgenes och personlighet. Lund, Sweden: Lund University Press. Andersson, A. L. (2004). Spiral Aftereffect Technique (SAT) and Defense Mechanism Technique modified (DMTm). Department of Psychology, Lund University, Sweden. Andersson, A. L., & Ryhammar, L. (1998). Psychoanalytic models of the mind, creative functioning and percept-genetic reconstruction. Psychoanalysis and Contemporary Thought, 21, 359–382. 136 Kristian

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Siever, L. J., Bernstein, D. P., & Silverman, J. M. (1989). Schizotypal, paranoid and schizoid personality disorders: A review of their current status. Unpublished manuscript. Sjöbäck, H. (1972). Projektet “Optimering av fältundersökning med experimentell personlighetsdiagnostisk metod (Defense Mechanism Test),” Department of Applied Psychology, Lund University. Sweden. Smith, G. J. W., Johnson, G., & Almgren, P.-E. (1989). MCT – The Meta Contrast Technique. Manual. Stockholm: Psykologiförlaget. Smith, G. J. W., & Carlsson, I. (1990). CFT – Test på kreativ funktion. Manual. Stockholm. Psykologiförlaget. Sundbom, E. (1992). Borderline psychopathology and the Defense Mechanism Test. Doctoral dissertation, Sweden: University of Umeå, Department of Applied Psychology. Von der Lippe, A., & Torgersen, S. (1984). Character and defense: Relationships between oral, obsessive and hysterical character traits and defense mechanisms. Scandinavian Journal of Psychology, 25, 258–264. 138 Kristian Important Announcement Dr. Amool Ranjan Singh, Ph.D. Professor and Head , Department of of Clinical Psychology, RINPAS,Kanke,Ranchi-834006(India) E-mail: editor_sis@rediffmail.com Mob.: 91-9431592734 has taken charge of the office of Editor In Chief SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH From January 2006 Institutional Members (Libraries of National and International Universities) are requested to send their Annual Subscription/Dues to Dr. Amool Ranjan Singh, Ph.D. Professor and Head, Department of of Clinical Psychology, RINPAS,Kanke, Ranchi-834006 (India) E-mail: editor_sis@rediffmail.com Mob.: 91-9431592734 The Subscription Cheque should be made in favor of “SIS Journal of Projective Psychology & Mental Health” payable at Ranchi (India)

Personality Assessment of A Child With Emotional Problems: A Case Study Nilanjana Sanyal, Manisha Dasgupta, Danae Marinakis and Olga Doukas The paper highlights the clinical probings of a case, aged 12 years, second-born, belonging to a family of lower socio-economic strata, and having emotional problems. She was administered with the Fairy Tale Test (F.T.T.) which was readministered for checking the reliability of the findings. The Draw-A-Person Test (D.A.P.) was also administered in the second phase for cross validation of the findings. Results revealed striking congruence of the signs of the searches in relation to the clinical delving of the interview, the Fairy Tale Test and the Draw-A-Person Test, thereby hinting at the significance of the rich penetrative tapestry of projective tests in tune with the skilled “clinical lenses of the therapist.” The case, Pooja, a female child of 12 years, had been located in a NGO-sponsored school in Tangra area of Kolkata. She was from a slum-dweller’s family and was a regular student of a Class V in this school. Certain distinctive personality features like reserved orientation, extremely poor verbal exchanges with friends, attention-drawing regarding teachers and unusual sincerity (unlike the students of her socio-economic strata) in studies marked her as very different from the rest of the crowd there. The principal teacher also expressed her desire to have a clinical probing into Pooja’s personality as she banked on her good performance and hence the reputation of the school. Thus, Pooja came into the focal lens of the present clinical study. Background facade? A young girl of 12 years, studying in Class V of a N.G.O.-sponsored school.? She had three more siblings, one elder brother (aged 14 years), and two younger brother and sister of 10 years and 7 years respectively. She had her mother, being the bread-earner of the family.? She lost her father a few years back in a sudden occasion where she came to know that he had developed bad stomachache in the early morning. Without telling anybody, he left for the hospital, being accompanied by a neighbor fellowman, got him admitted there and in the evening, died of unknown cause to her. The mother worked as domestic help in several families but in between her work schedules, she comes into the house, takes care of household works like cooking, cleaning, massaging oil or helping two small children and giving them bath, offering food to the client, taking her own food and going back to work.? The client reported that her mother is educated formally up to standard IX before her marriage. Nilanjana Sanyal, Professor and Former Head, Manisha Dasgupta Research Fellow and Guest Lecturer Department of Psychology, University of Calcutta , Calcutta, Danae Marinakis, MA in Counseling Psychology and Olga Doukas, DESS de psychologie clinique Corresponding address: Prof.(Dr.) Nilanjana Sanyal, 119,, Dr. Meghnad Saha Sarani, Greenview” 8thFloor,N/W Kolkata-7000029 Email: sanyal_nilanjana2004rediffmail.com Key Word : Clinical penetrative capacity of Fairy Tale Test SIS J. Proj. Pst. & Ment Health (2006) 13 :139-146

The mother had the strong urge to pursue the client with her studies and definitely with the study of the eldest son whom she had sent to her parents’ place for attaining formal education. The boy also seemed to have a good sense of responsibility regarding his own study, basic purposes in life and seems to be loving and caring about the client.? The client finds quite a lot of concern for herself on the part of her elder brother. The mother seemed to be the chosen role model for the client.? She reported her affinity towards the father and revealed her sorrow over loosing him so early in life.? She reported a balanced conjugal bond between the parents within the folds of her perception. Client’s present schedules and aspirations and current mental state: She is a neatly dressed-up girl, seems self conscious in presenting herself to others. She was wearing matched kurta and pajama, though of inferior dress material at par with their socio-economic level. Her garbs were extremely feminine. Her hair was neatly tied up. She was wearing imitation/ “junk jewelry” earrings, necklace and matched bangles. She seemed to be a very quiet, modest, well-behaved and well-communicative child. In her response pattern, her intellectual sharpness was revealed in her being focused on what she does, why she does it and what she wants to do in future. Her general daily schedule included time-bound study pattern in the afternoon at school; in the early evening, with a supportive N.G.O. free-coaching centre and at night, to do the homework with the help of her mother. She also looked after a few daily chores like helping the mother at home by holding younger siblings when required, helping her to help them go to sleep, and in the afternoon, when she comes back home to have her mid-day meal, she fed the younger siblings, necessarily the brother, while the mother prepared food for the whole family. She seemed to be extremely obedient to her mother and never went out to develop friendship in the neighbourhood, always tried to utilize the time to the best of her ability and follow the mother as much as it was practicable for her. She reported her occasional urge of being with friends, playing with them and watching T.V. but she resisted her desires and compromised utterly with the mother’s dictums to earn her approval to the fullest in her life. She seems to be extremely defensive in her impulse control, specially the aggressive/ sexual ones (primitive ones). She reported her dream of being a doctor in life to save poor people of their ageing or else be in a respectable job. On the other hand, she revealed her desire to get a properly educated marriage partner in life who would be the mentor in her life in every possible respect. But in an overall stance, she revealed her suppressed sibling jealousy regarding the younger siblings whom she found to be the centre of her mother’s attention and care. She openly craved for her mother’s love, affection and pettings in an extremely regressive Style. 140 Sanyal et al

The signs of searches in the personality: An established identity of her own, owing to the fulfillment of her narcissistic desire.Conscious manipulated self-representation to earn the mother’s approval and at the same time fulfilling the hysterically-oriented attention drawing capacity regarding heterosexual members of the society, i.e., enjoying feminity in the hysterical foldings or oedipal holdings. Her affinity to the father, elder brother and aspiration to have a mentor-like partner reveals her intense female desire to winning the potent father-figures’ attention and approval for she craves for the satiation of her oedipal wishes. Putting herself on the mother’s track to develop required self-adequacy through identification with her revealed distinct personal qualities, thereby avoiding the wrath of the mother in oedipal conflict. Socially moulded self-presentation to be the centre of everyone’s attention with apparent shyness and reserved personality coverings, thereby creating the spectrum of feminine glamour. Regressive holding/ attachment to the mother to keep aside all conflicts of growing years. Intense personal care to the younger brother, thereby expressing her hysterical urge to have a son and fulfillment of penis-envy. Tests administered: A detailed interview was conducted with the case at the beginning. Pooja was administered with the Fairy Tale Test (F.T.T.) (Coulacoglou, 2003) after the establishment of adequate rapport. The test was re-administered after five months for checking the reliability and consequently for the confirmation of the findings that depicted the presence of clinical features. The Draw-A-Person Test was also administered in the second phase of the testing session for cross validation of the findings obtained by the projective (namely, the F.T.T.) with a semi-projective test (namely, the D.A.P.) . Test behavior: Pooja showed active cooperation and interest in the F.T.T. cards and responded to each of the questions in the test and re-test conditions without much difficulty. It was relatively convenient to establish rapport with her in both the sessions. However, she showed reluctance in drawing the human figures in the Draw-A-Person Test and told that she could not draw anything at the outset, though she later managed to sketch two human figures. Results: Pooja’s protocol was chosen for presentation not only as an example of a clinical case, but also because her responses and the symbolic themes reflected through them support the traditional psychoanalytic interpretations (Bettelheim, 1976) of classic fairy tales. Personality Assessment thru Fairy Tale Test 141

Table 1 T-scores of the case for each of the different personality variables in test and retest conditions Variables T scores in Test Condition T scores in Retest Condition Ambivalence(AMB) Desire for material things (DMT) Desire for superiority (DSUP) Self-esteem (SE) Sense of property (SPRO) Sense of privacy (SPRIV) - - Aggression as Dominance (AGGRDOM) Oral aggression (OA) Oral needs (ON) Aggression type A (AGGRA) Aggression as retaliation (AGGRET) Aggression as envy (AGGRENVY) Aggression as defense (AGGRDEF) Instrumental Aggression (AGGRINSTR) - - Fear of aggression (FA) Need for affection (NAFCT) Need for affiliation (NAFIL) Desire to help (DH) Need for protection (NPRO) Anxiety (ANX) Depression (D) Adaptation to the fairy tale content (AFTC) Bizarre (B) Sexual Preoccupation (SEXPREO) Morality (MOR) Relationship with mother (REL/MO) Relationship with father (REL/FA) Repetitions (R) Need for approval (NAPPRO) _ _ Discussion: Interpretation of findings obtained from the Fairy Tale Test Table 1 reveals that Pooja has an immense anxiety over loss (possibly because of the absence of her father and being emotionally distant from her mother, though she has a defensive orientation to prevent others understand the same), deprivation (emotional and material), punishment and rejection. Her feelings of anxiety are accompanied by feelings of sadness. Some of her most characteristic responses are presented below: “Here are three pictures of LRRH. What does each one think and feel? (Why?)” (Test condition) 142 Sanyal et al

Card II: RRH is hopeful that her mother will be saved (?) but her mother will die (?) because her mother is very sick (?) she’ll bring medicine, take her to the hospital but still her mother will die (?) then she’ll feel sad, feel lonely, and roam about. (AFTC 1, B, D3, DH3, ANX3 loss) Card III: (Test condition) She’s going to the market to bring food. She’s thinking that my mother is dead. No one will give me food to eat. So I’ll go to the market (?) She does not have money, so she’ll ask for money from others and may pick from the road (?) no one will give her money (?) She’ll take help from her father. (AFTC 1, B, ANX 3 deprivation, D3, ON 2, DMT 2) Indications of sexual preoccupation are present, that are in accordance with her age, but are also followed by statements conveying anxiety punishment and disapproval (by parents/ parental figures), thereby hinting that her sexual development might be prohibited. The following are some characteristic responses: “Here we have three scenes from the story of LRRH. Please describe what is going on in each picture.” Card I: (Test condition) LRRH’s mother is scolding her, “Where did you go without informing me?” (?) LRRH replied, “Sorry, it was a mistake; from next time onwards, I’ll inform you of the same.” LRRH had gone to play and had slept in a boy’s room (?) but did not say anything to her mother (?) because she’s fearful of her. (AFTC 1, SEXPREO 2, MOR 1, ANX 1 punishment, REL/MO -1) Her adaptation to the fairy tale content in either of the conditions is rather low, while the content of the bizarre responses relates to the variables of anxiety loss, negative relationship with mother and sexual preoccupation. It seems that her inner concerns and conflicts take over and thus the reality of the fairy tale content is set aside. Her difficult relationship with her mother is more directly expressed in the retest condition than in the first administration as can be understood from her response: “Here are three pictures of LRRH. What does each one think and feel? (Why?)” Card I: (Retest condition) She is thinking why am I not getting love and affection from my mother unlike that obtained by other children from their mothers (?) She’s feeling unhappy (?) she’s not getting love and affection from mother (?) I think she’ll not do anything to obtain her affection (?) for she does not like her mother. (AFTC 1, ANX 2 deprivation, NAFCT 2, D1, REL/MO -1) The case’s fear of aggression is relatively high, leading to the phenomenon of over involvement in one instance, which can be understood as: “Which of the three witches scares you most. Why?” Personality Assessment thru Fairy Tale Test 143

Card III: Because her eyes are big. She feels as if to hit the girl SW, and may hit myself as well. (FA 3, Over involvement) It indicates that the child is afraid of others and as a result, real and imaginary aggression are confused. The desire for material things, her need for affection as well as her need for affiliation are also expressed. Her moral development (or super-ego), appearing in normal levels, helps her cope with the desire for material things and aggressive impulses. The defense mechanisms that the case employs are rationalization, projection and splitting of mother. The defense mechanism of spitting of mother seems to be employed against the anxiety evoked by the negatively perceived relationship with her mother, followed by the mechanism of projection to justify her own aggressive impulses. LRRH Card III (Retest condition): “She’s thinking that my earlier mother was good. This new mother has made my father bad and also turned me bad. It seems that she might send me out of the house within a few days (?) she’s feeling sad… It indicates that the child probably unconsciously blames her mother for her father’s death and is (unconsciously) afraid that the same might happen to her. The use of rationalization can be understood from the characteristic response of the subject as: Dwarf Card I (Test condition): “He is thinking who the girl is, from where has she come from, what will people say if she stays with us for we are children and she’s a girl (?) he’ll allow her to stay in his house but in a separate room, not in his own room (?) because other people may come and complain against them. AFTC 2, ANX 1 disapproval, SEXPREO 1, Rationalization) These defenses seem to be the unconscious tools against anxiety of being rejected and punished when it comes to family interactions (and mother-child relationship) and against anxiety of being disapproved when it comes to sexual preoccupation. Thus, though Pooja’s responses share different contents in the test and re-test, the main themes and variables are interestingly repeated in these contexts. The themes that are reflected in both administrations are: * anxiety of being materially and emotionally deprived * feelings of being rejected by the family environment * sadness and loneliness. The needs revealed are: * need for affection * need for protection An observed difference between the test and re-test conditions is that, in the second administration, the main themes revealed are directly expressed while in the first 144 Sanyal et al

administration, most of the themes are indirectly expressed or just implied. This may be due to familiarity with the test situation and with the examiner as well as due to continuing problems in the family environment. Family therapy is strongly recommended. Interpretation of findings obtained from Draw-A-Person Test The D.A.P. reveals an interesting bent to those obtained from the F.T.T. Both the profiles of the human figures seem to be immature in relation to Pooja’s age. (Golomb, 1990 and Gardner, 1980), thereby hinting at the regressive tendencies of the client. According to Benveniste (2005), immature, non-elaborated drawings might reveal a restriction of the ego or inhibition. This suggest her non-expression of desires or impulses on the whole. Her relatively small eyes in comparison to the size of the head, probably expresses her lack of interest for the external environment. (Widlocher, 1965). Besides,, the girl probably feels anxious of her sexual preoccupations and regresses to earlier stages of development in order to cope with her anxiety. She also has limited vital power (Widlocher, 1965), or lacks investment in life. A feeling of guilt (Widlocher, 1965), probably associated with a problem with the mother is also reflected along with the presence of emotional deprivation. This expresses her maladaptive attachment to her mother so as to imbibe a sense of adequacy from her. Hence, to sum up, it may be inferred that the absence of vitality and the immature representations (with regard to her age) of the two drawings, along with sexual and aggressive connotations, could be indicatives of symptoms related to depression. Association between D.A.P. and F.T.T. Depression, anxiety over sexual concerns and oral aggression were observed in both tests. Emotional and material deprivation was a major theme appearing in the F.T.T., which may be linked to the D.A.P. observations: lack of mouth and poor body representations. Additionally, the hypothesis that the absent mouth in one case (girl image) and the aggressive mouth in the other (boy image) might be related to a difficult relationship with the mother, is supported by Pooja’s responses in the F.T.T. Consensual “signs of searches” in relation to the probings of the clinical interview, F.T.T. and the D.A.P. * Her defensive personality orientation to seek approval of significant others, especially her mother by nourishing her sense of feminity though “hysterical clutches.” * Intense oedipal cravings from father and father-like substitutes, along with the wraths of anxiety and guilt associated with sexual concerns. * Regressive trend in the mosaic of her personality being attached to the mother in a maladaptive fervour. Latent castration-anxiety. * Depressive flavour encompassing her cognitive-affective and conative trio junctures. * Appreciably high cravings of love, affection and affiliation from “significant others.” * Presence of high loadings of aggression which is concealed by the case owing to her intense need for social approval. Personality Assessment thru Fairy Tale Test 145

Highlights of the study: The case study sheds light to the penetrative capacity of projective techniques in unveiling one’s personality and also to the sufficiently high and dependable inter-test reliability, that adds to the clinical significance of projective techniques (Kitron and Benziman,1990; Barlow, Jolley, White and Galbraith, 2003). A schematic representation of the personality profile of the case may be provided as. Fig.1 Schematic representation of personality profile of case References: Barlow, C.M., Jolley, R.P., White, D.G. and Galbraith, D.(2003). Rigidity in children’s drawings and its relation with representational change. Journal of experimental child psychology; 86(2): 124-152. Benveniste, D. (2005). Recognizing defenses in the drawings and play of children in therapy. Psychoanalytic Psychology, 22, 3, 395-410. Bettelheim, B. (1976). The Uses of Enchantment: The Meaning and Importance of Fairy Tales. New York: Knopf.Coulacoglou, C.(2003). The Fairy Tale Test. Manual. Toronto: Multi Health Systems, Inc. Gardner, H. (1980). Artful scribbles: The significance of children’s drawings. New York: Basic Books. Golomb, C. (1990). The child’s creation of a pictorial world. Berkeley: University of California Press. Kitron, D.G. and Benziman, H.(1990). The children’s apperception test: possible applications for adults. The Israel Journal of Psychiatry and Related Sciences; 27(1): 29-47. Widlocher, D. (1965). L’interprétation des dessins d’enfants. Dessart, Psychologie et Sciences Humaines, Bruxelles. Note: (The authors are indebted to Dr. Carina Coulacoglou, Child Psychologist, 40E Esperou Str., Kifissia, Athens, Greece, test developer of the Fairy Tale Test, for her wholehearted support and cooperation in preparing this article.) Affection S Depression S Anxiety over sexual concerns and loss S Emotional and material deprivation S Need for affection and affiliation Cognition S Sexual preoccupation S Ambivalent relationship with mother S Defenses- rationalization, projection and splitting of mother Conation S Aggressive orientation (that remains latent) S Absence of vitality S Less interactive with friends S Difficulty in concentration S Poor attention span S Poor performance at school 146 Sanyal et al

Novelty and Meaning Contexts of Creativity vis-a-vis Jensen’s Level I and level II Abilities Umed Singh The present study was designed to examine the relationship of novelty and meaning contexts of creativity with Jensen’s Level I and Level II. Psychometric measures of creativity like Torrance Tests of Creative Thinking are considered to measure novelty context of creativity, whereas projective indices, particularly inkblot techniques are taken to index the meaning context of creativity. Likewise measures of learning/memory viz. Forward Digit Span, Backward Digit Span, and Serial Rote Learning are the indices of level I ability; and Raven’s Progressive Matrices and Verbal measures of general mental ability like Hundal’s General Mental Ability Test are considered to tap Jensen’s level II ability. To realize the main objective of the study 202 high school male students were randomly drawn from Kurukshetra District of Haryana. The selected subjects were administered Holtzman Inkblot Technique (HIT), Torrance Tests of Creative Thinking (both verbal and figural), Forward Digit Span, Backward Digit Span, Serial Rote Learning, Raven’s Progressive Matrices, and Hundal’s General Mental Ability Test. The obtained data were analyzed by applying descriptive statistics, Pearson’s Correlations, and Principal Component Factor Analysis. Analyses have clearly established the two contexts of creativity i.e. novelty and meaning, and differential relationships with Jensen’s level I and level II abilities. Analysis also supports Jensen’s hypothesis of factorial distinction between level I and level II abilities. Weak associations have been obtained between psychometric measures of creativity (novelty context) and the indices of level II ability. Overall, findings of the present study highlight the complexity of relationship between creativity and intelligence. From the time of Galton, psychology has evidenced un abiding interest in understanding both the intellectual and creative acts. Much of the researches in these fields have been carried out in the hope that a sound understanding of these would lead to more effective use of these precious mental resources in a world of rapid evolutionary social and technological changes. Intelligence and creativity are the constructs with many meanings. The term intelligence has been used variously to refer to (a) that which IQ tests measure; (b) the entire multi factorial domain of human cognitive abilities (including divergent thinking abilities, problem finding abilities, special talents such as musical and artistic abilities, and the abilities to access primary process modes of thought); and (c) that which qualified observers describe as intelligence (implicit theories) on the basis of repeated observations of behavior in many situations. Similarly, numerous definitions have been extended for creativity, which Rhodes (1961,1987), Mooney (1963), and Runco (2004) have endeavored to condense into four distinct approaches – (a) as product, (b) as person, (c) as press, and (d) as process. From these various definitions of both the intelligence and creativity it can be inferred that intelligence is critical in adaptation with the existing environments, whereas creativity which involves the production of an idea or product that is both novel and useful, has been viewed as critical to the modification or shaping of these environments. The empirical investigation of intelligence-creativity relationship dates back to 1950 when J.P. Guilford voiced in his APA Presidential address, stressing the construct independence between creativity and intelligence; and highlighted the paucity of research in these basic areas of human mental functioning. Since then many scholars Umed Singh, Reader, Department of Psychology, Kurukshetra University, Kurukshetra, Haryana, Email: Umedsingh_78@yahoo.com. Key Word : Creativity, Novelty Context, Meaning Context, Level I and Level II Abilities. SIS J. Proj. Pst. & Ment Health (2006) 13 :147-160

have endeavored to produce a number of major or specialized reviews and reference books (Stein, 1968; Gilchrist, 1972; Barron and Harrington, 1981; Mumford and Gustafson, 1988; Sternberg, 1988, Runco, 1998a, 2003a, 2003b) dealing with this controversial issue. The controversy regarding the relationship, according to Foster (1971); and Barron and Harrington (1981) centers around three standpoints: (1) creativity is hypothesized to have high positive relationship or it is an integral part of intelligence; (2) creativity has weak relations with intelligence or both are distinct and independent of each other for all practical purposes; and (3) a curvilinear relationship between creativity and intelligence, meaning thereby intelligence becomes less and less influential in creativity as the level of intelligence moves higher. Cattell (1971) is well known for his theory of crystallized and fluid intelligences. He contended that intelligence be viewed hierarchically with general ability at the top and two broad factors right below it. Crystallized ability, measured by tests of verbal comprehension and general knowledge, refers to one’s accumulated store of information. Fluid ability, measured by tests of abstract inductive reasoning, refers to one’s ability to acquire and utilize information in novel contexts. Cattell expanded further upon these factors and posited a list of primary abilities that are similar to, but less complex than Guilford’s 150 factors. Cattell believed that real-life creative performance is determined by one’s general intelligence first, particularly fluid intelligence as opposed to crystallized intelligence, and then by personality factors. Renzulli (1986) has attempted to explain intelligence – creativity relationship in terms of three – ring model depicting that two overlap (e.g. creative people need a certain IQ level) but are non-identical. According to this model, giftedness is at the intersection among above-average ability, creativity, and task commitment. The circles for ability and creativity thus overlap. Some studies have been carried out by using different types of indices of intelligence as well as creativity i.e. verbal and non-verbal measures of intelligence, and projective and psychometric indices of creativity. These studies have clearly reported that both the constructs are highly complex and multifaceted; and their mutual relationship is also multidimensional (Kamlesh, 1979; Ramchandran, 1994; Jalodia, 1995; Minhas and Young, 1985). It has also been suggested that the relationship between the two differs across types of tests, samples, and contexts used in the studies. Review of literature pertaining to creativity reveals, that creativity has been indexed by psychometric measures, in most of the studies. This psychometric revolution of measuring creativity had both positive and negative effects on the field. On the positive side, the tests facilitated research by providing a brief, easy in administration, scoring and objective assessment device. However, there are some negative effects as well. First, some researchers have criticized psychometric tests as trivial and inadequate measures of creativity. Second, some critics suggested that neither fluency, flexibility, originality, nor elaboration score, capture the whole domain of construct of creativity. Stark (1965a, 1965b) attempted to develop the dualistic conception of creativity most systematically in terms of two contexts: (a) context of novelty as in originality or scientific invention, and (b) context of meaning as in dramatic dreaming (Demeiut, 1965). These two contexts correspond to creativeness in the domains of science and arts respectively. Stark has contended more strongly that the modern psychometric tests of creatively are biased in favor of scientific creativity and are deficient in tapping the traditional type or meaning type of creativity. Drawing upon various studies, Stark has proposed that 148 Singh

projective measures, particularly inkblot tests are true indices of meaning or traditional type of creativity. The present study is an attempt to understand the multidimensionality of creativity-intelligence relationship more systematically by using projective and psychometric indices of creativity to represent meaning and novelty contexts of creativity; and verbal and non-verbal measures of intelligence representing Jensen’s level I and level II abilities. Method: The sample for the present study consisted of 202 high school students of 9 th and 10th grade drawn from various schools of Kurukshetra District in Haryana. The sample was restricted to urban areas and consisted of only male students ranging in age from 14 to 16 years with the mean age of 15 years. Only male students were included in the light of reported sex differences in creativity by some researches (e.g. Torrance and Aliotti, 1969; Ruth et al., 1985; Richardson, 1986). Measures: Measures used in the study are: Holtzman Inkblot Technique (HIT) was developed by Holtzman et al. (1961) It consists of two parallel forms (A & B), with 45 cards. The test involves a well standardized procedure of administration and scoring of 22 variables viz. Reactive Time, Rejection, Location, Space, Form Definiteness, Form Appropriateness, Color, Shading, Movement, Pathognomic Verbalization, Integration, Content, Anxiety, Hostility, Barrier, Penetration, Balance, and Popular. Richter and Winter (1966) have reported the relationship of few HIT variables with divergent thinking. Notables of these are: Location, Color, Movement, Anxiety, Hostility, and Penetration. These variables have been regarded as indices of “meaning context” of creativity. Gray (1969), Kamlesh (1979) and Jalodia (1995) have also reported the usefulness of these HIT variables in indexing creativity. HIT being an individual test was administered individually strictly following the instructions mentioned in manual. HIT was scored only for six variables viz. location, movement, anxiety, hostility, color, and penetration following Richter and Winter’s (1966) recommendations, that they index the “Meaning Context” of creativity. Torrance Tests of Creative Thinking comprises a verbal battery (seven subtests) and a pictorial or figural battery (three subtests). The first battery is labeled as “Thinking Creatively With Words”, and the second, “Thinking Creatively With Pictures”. The tests are considered suitable for kindergarten to graduates, although below the 4th grade these are to be administered individually and orally. Two equivalent forms (A and B) of each battery are available. Both the verbal and figural tests have been used in the present study to index the ‘Novelty Context’ of Creativity. The verbal test consists of seven subtests’ battery known as “activities”. Figural test consists of three activities. Each activity is believed to bring into play somewhat different mental processes, yet each requires the subject to think in divergent directions. Scoring of these activities provides scores for four basic dimensions of creativity namely, fluency, originality, flexibility, and elaboration.Torrance tests of creative thinking being group tests were administered in classroom setting in groups of 15 to 25 subjects according to the prescribed procedures. Torrance Figural Test of Creativity was scored for four factors of creativity i.e. fluency, originality, flexibility and elaboration whereas verbal test was scored only for three factors i.e. fluency, originality and flexibility. Elaboration was not scored for some technical grounds. Creativity through Holtzman Test 149

Raven Progressive Matrices (1985) was constructed primarily as a measure of Spearman’s ‘G’ factor. The Standard Progressive Matrices (sets A, B, C, D & E) is a test of person’s capacity to apprehend meaningless figures, to see relations between them and to conceive the nature of the figure completing each system of relations presented. The scale consists of 60 problems divided into five sets of 12. Hundal’s General Mental Ability Test (1962) is a group test initially designed to measure the general mental ability of Punjabi speaking subjects. It consists of 100 items divided into seven subtests. These are: Number Series (NS), Analogies (An), Classification (C), Inferences (In), Following Directions (Fd), Opposites (Op), and Synonyms (Sy). All the 100 items are arranged spirally in ascending order of difficulty. Memory for Numbers: In the present study the FDS and BDS have been used as measures of level I ability. For FDS three tests consisting of seven strings of digits from 3 to 9 were prepared controlling every possible association between the digits and between the strings. Similarly, three lists of digit series were also prepared for BDS. Both the tests were presented at a constant pace of 1 second per digit. In FDS subjects were required to reproduce the series in the same order while in BDS, in reverse order. Three trials were given on each series and score of 1 was given to each correct reproduction. Serial Role Learning: Originally, Ebbinghaus employed serial learning method in his memory experiments. It bears two characteristics. First, the order of items typically is held constant in presentation from trial to trial and items are counted correct only if subjects recall them in the same order. Second, subject is usually asked to anticipate the subsequent items. Jensen (1969, 1970) in his level I and level II abilities theory building experiments has repeatedly used serial rote learning as a measure of level I ability. In the present study this procedure was employed by designing a list of 12 trigrams with controlled association values of these items. The list was presented trial after trial employing the anticipation procedure till the achievement of successful learning criterion. Number of trials taken in the successful reproduction of items in the serial order was taken as the score. Administration and Scoring: The testing sessions were conducted in classroom settings. Torrance tests of creative thinking (both verbal and figural), Hundal’s General Mental Ability Test, and Raven’s Progressive Matrices were administered as group test in a group of 15-25 subjects in respective classes. Memory for numbers (FDS & BDS), Serial Role Learning, and Holtzman Inkblot Test were administered individually. Series of digits for FDS & BDS were presented through audio tape recorder paced at 1 second per digit and with constant inter trial internal of 1 minute. Three trials were given for each series. BDS followed FDS in testing with an interval of 10 minutes between the two. Serial Role Learning material was visually presented on memory drum with controlled distance and exposure interval. List of items was presented to each subject up to the achievement of successful learning criterion employing anticipation procedure. Number of trials taken in successful learning of list was recorded for each subject. The test were scored as per manual of the test. HIT was scored for only six variables, viz. Location (L), Color (C), Movement (M), Anxiety (Ax), Hostility (Hs), and Penetration (Pn). Torrance Test Of Creative Thinking With Words was scored for fluency, flexibility, and originality according to scoring guide by the author. Elaboration was dropped on 150 Singh

some technical grounds. Torrance Test Of Creative Thinking With Pictures was scored for four factors i.e. fluency, flexibility, originality, and elaboration. This way a total of 24 measures (7 of GMAT, 1 of RPM, 3 of Memory/ Learning, 6 of HIT, 3 of TTTC- Words, and 4 of TTTC – Pictures) were used in the present study. Results and Discussion: The obtained data were analyzed by using various statistical techniques most pertinent the descriptive statistics (Mean, Standard, Deviations, Skewnesses, and Kurtoses), Pearson’s correlations, Principal Component Factor Analysis, and Inter-battery Factor Analysis. Frequency distributions for all the 24 variables used in the study were set up for the total group of 202 subjects to ascertain the normalcy of data. Obtained patterns of descriptive statistics (Table I) depicts the data to be normally distributed except some minor discrepancies in some of the distributions, particularly, HIT variables. Table 1 Descriptive Statistics S. No. Variables Code Mean SD SK Ku RXX* 1. Number Series N 4.82 2.78 .38 3.00 .61 Test-Retest 2. Analogies A 9.08 3.13 .46 2.59 .65 “ 3. Classification C 6.60 1.98 .06 3.93 .62 “ 4. Inferences Inf 2.25 .99 .11 2.89 .59 “ 5. Following Direction FD 5.71 2.53 .00 2.75 .67 “ 6. Opposites D 4.95 2.13 0.10 2.43 .81 “ 7. Synonyms Sy 4.76 1.93 .20 2.45 .77 “ 8. Raven’s Pro.Maytr RPM 37.11 8.20 .09 2.39 .80 “ 9. Farward Digit Span FDS 5.12 .99 2.54 .96 “ 10. Backward Digit Span BDS 4.01 .87 .62 3.52 .93 “ 11. Serial Rote Learning SL 10.31 3.94 .22 3.41 .86 “ 12. Location L 32.17 10.05 .07 2.82 .99 Inter-scorer 13. Color Co 19.50 11.90 .21 2.54 .93 “ 14. Movement Mo 25.12 11.78 .05 2.64 .95 “ 15. Anxiety Ax 10.01 4.89 .18 2.69 .91 “ 16. Hostility Hs 10.15 5.45 .48 3.10 .89 “ 17. Penetration Pn 6.75 3.11 .45 3.45 .90 “ 18. Originality Fo 29.55 9.93 .17 2.65 .78Test Re test“ 19. Fluency FFl 21.32 7.63 1.14 4.98 .81 “ 20. Flexibility FFLX 14.69 4.06 .01 2.39 .77 “ 21. Elaboration FE 59.00 16.94 .00 3.61 .69 “ 22. Original Verb VO 27.63 11.68 2.55 8.14 .77 “ 23. Fluency VFL 54.23 17.76 .18 3.50 .79 “ 24. Flexibility VFLX 15.98 3.52 .03 3.63 .65 “ * RXX – Reliability Coefficients Reliability coefficients for all the measures with respective methods as mentioned in Table I, have been found to be satisfactory. Creativity through Holtzman Test 151 HIT GMAT FIGURAL CREATY CREAT

152 Singh Table 2 Intercorrelations Matrix N A C INF FD O Syn RPM FDS BDS SL L Co Mo Ax Hs Pn FOFFlu FFlx FEl Vo VFlu VFlx N -03 -02 -02 -10 17 19 26 19 A -08 -04 -16 -04 -03 -01 07 01 12 -01 11 C -09 -04 -15 10 07 17 -02 05 INF -08 -01 19 22 28 11 FD -15 -19 -15 -01 13 14 17 01 -07 -12 O -03 -01 -17 -04 -02 12 -09 15 Syn -05 -09 -02 11 08 21 02 RPM -06 -07 -11 19 09 17 17 FDS -33 -08 -10 -12 -13 -17 -21 -11 BDS -32 -05 -05 -05 -18 -19 -08 -10 -08 -16 SL -05 -03 -05 11 13 17 07 -10 -05 L -26 -18 -08 -24 -06 04 15 20 13 -07 -02 Co -06 00 -03 09 -06 Mo -07 10 07 -03 11 -04 -08 -03 Ax 59 26 01 -07 -05 02 01 Hs 33 08 -03 -10 -01 -05 05 -02 Pn -08 -12 -06 -05 02 O 77 64 09 FFlu 82 68 07 FFlx 61 14 FEl Vo VFlu VEl — Note: r = .14 p<.05, r = .18 p<.01, Decimal points omitted

Pearson’s correlations have been computed among all the 24 variables (Table II). Degree of freedom being 200 (N-2), correlation coefficients of .14 and .18 are significant at .05 and .01 levels respectively, Though, these bivariate correlations reveal meaningful information about the commonality among variables, yet a precise picture of this overlap can best be revealed through factor analysis. So, the inter-correlations were not interpreted rather inter-correlations matrix was subjected to Principal Component Factor Analysis to understand the structure of overlaps between different indices of intelligence and creativity. The Principal Component Analysis (Hotelling, 1935) yielded seven factors with eigen values greater than 1.00 which accounted for 67.75% of total variance. These factors were subsequently rotated to Kaiser’s (1958) varimax criterion of orthogonal rotation. The rotated component matrix appears in table III. Table 3 Rotated Factor Matrix Factors Variables I II III IV V VI VII h2 N .79 .19 .05 .02 .03 .08 .02 .67 A .72 .07 .10 .22 .01 .16 .25 .66 C .70 .05 .18 .04 .03 .15 .17 .57 INF .67 .23 .05 .03 .09 .21 .18 .58 FD .67 .09 .12 -.22 .00 -.26 .20 .63 O .76 .10 .08 .19 .05 .13 .04 .65 Syn .75 .00 .15 .28 .11 .08 .06 .68 RPM .23 .11 .02 .21 .12 .30 .63 .61 FDS .05 .12 .01 .14 .90 .08 .04 .82 BDS .08 .06 .08 .07 .90 .01 .01 .79 SL .01 .13 .04 .01 -.52 .12 -.40 .47 L .03 .19 -.24 .09 .01 -.55 .06 .41 Co .04 .05 .06 .04 .00 .85 .02 .73 Mo .07 .13 .73 .15 .10 .21 .09 .64 Ax .23 .05 .80 .90 .01 .01 .06 .70 Hs .07 .02 .87 .03 .16 .09 .16 .82 Pn .14 .15 .23 .19 .25 .06 -.65 .62 O .06 .90 .09 .09 .06 .04 .06 .82 FFlu .06 .93 .02 .06 .05 .06 .01 .88 FFlx .20 .86 .10 .11 .11 .07 .01 .83 FEl .03 .81 .05 .09 .08 .05 .07 .67 Vo .05 .07 .09 .69 .10 .26 .11 .57 VFlu .07 .12 .02 .83 .05 .05 -.21 .76 VEl .15 .15 .04 .78 .09 .11 .10 .63 % Cont. 16.20 13.90 9.02 8.93 8.36 6.12 5.25 Creativity through Holtzman Test 153

Perusal of rotated components matrix reveals that all the seven subtests of GMAT have loaded significantly with high positive loadings ranging from .67 to .79 on factor – I. Verbal measures such as subtests of GMAT have been regarded as measures of crystallized intelligence by Cattell (1963), and of Level II ability by Jensen (1973). Raven Progressive Matrices has also born out some considerable positive loading here on this factor. On the basis of nature of markers, this factor can be labeled as a factor of Level II Ability. It accounts for 16.22% of total variable. With this finding one of the two-second order factors of general intelligence in Cattell’s model has clearly been replicated. It also provides empirical support to Cattell’s (1971) ‘investment hypothesis’ that gf and g c are correlated positively with low to moderate magnitude and g f is invested in the cultivation of g c. The measures of memory for numbers, and serial role learning (measures of level I ability in Jensen’s model) have very low (near zero) loadings on this factor, so this finding also provides support to Jensen’s hypothesis of factorial distinction between level I and level II abilities. It is worth noting that both the projective and psychometric measures of creativity representing meaning and novelty contexts have not shared their variance substantially with the markers of this factor depicting the construct independence between intelligence and creativity. Factor II has mainly been defined by four figural measures of creativity viz. fluency, originality, flexibility, and elaboration with positive loadings ranging from .81 to .93. Accordingly, this factor is conveniently labeled as Figural Creativity. It has accounted for 13.90% of total variance. Unexpectedly, the loadings of verbal measures of creativity are very low here suggesting to conclude that psychologically distinct processes are involved in thinking creatively with pictures and with words. None of the measures of intelligence, except inferences of GMAT has marked substantial association with this factor positing the low correspondence between creativity and intelligence. Similarly, projective measures of creativity (six HIT variables) have shared only a negligible portion of their variance with the figural measures of creativity. It provides support to Stark’s hypothesis of construct distinction between novelty and meaning contexts of creativity. Factor III mainly loads on HIT variables of Hostility, Anxiety, and Movement with the respective loadings of .87, .79 and .73. Variables of Location and Penetration have also yielded some considerable loadings on this factor (negative loading of Location indicates positive association because of its scoring procedure). All these inkblot indices have been regarded as measure of divergent thinking by Richter & Winter (1966), so this factor is named as Projective Creativity. It has accounted for 9.02% of total variance. None of the psychometric measures of creativity has marked substantial association with the markers of this factor, and hence, obtained structure clearly supports Stark’s contention of “measuring context” of creativity, which is distinct from “novelty context” as indexed by psychometric measures. Similarly, none of the measures of intelligence (level I and level II abilities) marks substantial association here on this factor. It again provides support to lack of overlaps between creativity and intelligence. Factor IV dominantly loads on three verbal measures of creativity viz. fluency, flexibility, and originally with the positive loadings ranging from .69 to .83, and hence is apparently a factor of Verbal Creativity. It accounts for 8.93% of total variance. Some of the measures of general intelligence/level II ability have also marked some substantial association with the salient of this factor suggesting that verbal measures of creativity share something with measures of general intelligence / level II ability. All the figural and 154 Singh

projective measures of creativity have very low loadings on this factor positing that creativity indexed by verbal, figural, and projective measures underlies more or less distinct cognitive processes. It also supports the construct independence between novelty and meaning contexts of creativity. More so, it suggests that to cover widest possible range of individual differences in creative thinking and to tap its multidimensionality, various types of measures should be employed. Factor V is clearly a factor of Level I Ability as it has loaded highly on FDS, BDS, and Serial Rote Learning with respective loadings of .88, .87, and -.52. Here the negative loading of Serial Learning posits positive association because of its scoring procedure. It has accounted for 8.36% of variance. FDS, BDS, and Serial Learning have been regarded as measures of level I ability by Jensen, (1971, 1973), Jensen and Figueroa (1975). Similar structure has also been obtained in some factor analytic Indian studies in India (Darolia, 1985; Singh, 1986; Kaur, 1989, Jalodia, 1995). With this finding, Jensen’s hypothesis of psychological distinction between level I and level II abilities has borne out clearly as the measures of general intelligence (level II ability viz. GMAT & RPM) have very low loadings on this factor. Similarly, both the projective (HIT) and psychometric measures (verbal & figural) of creativity also have negligible loadings on this factor, which posit the construct independence between creativity and intelligence. Factor VI loads highly on two variables of HIT viz. color and location with the loadings of .85 and -.55 respectively. Here, the negative loading of location indicates the positive association because of its scoring procedure. Verbal originality, matrices, and three subtests of GMAT have also marked some association here on this factor. On the basis of nature of markers, this factor can be named as a factor of Chromatic Sensitivity. It accounts for 6.12% of total variance. The obtained structure cannot be interpreted to depict some understanding pertaining to creativity intelligence relationship. Factor VII has been marked by matrices of RPM, penetration of HIT, and serial learning with the respective loadings of .63, -.65 and -.40. In view of these loadings, this factor appears to represent Fluid Intelligence. It accounts for 5.25% of variance. Both projective & psychometric measures of creativity have not shared their variance substantially with the markers of this factor. Similarly, verbal measures of intelligence have marked low but positive loadings except serial learning which posit low but positive association between measures of level I and level II abilities. On the basis of nature of markers having significant loadings, this factor can be considered as a broad factor interwoven with components of general mental ability, elementary cognitive ability, projective and psychometric creativity. Conclusions: The finding empirically supports that psychometric measures are biased to tap only the novelty context of creativity, and the meaning context of creativity is indexed through projective measures. Thus, these two contexts of creativity are quite distinct. In other terms it implies that scientific and artistic creativity are conceptually distinct. So far as the relationship of these contexts with level I and level II abilities is concerned, the present findings depict some structured overlap between level II abilities and psychometric or novelty type creativity, but not with the meaning type or artistic creativity. On the other, measures of level I ability have shared variance substantially neither with the measures of novelty nor with the meaning context of creativity. Secondarily, the findings of the present study also shed significant light on the relationship of gf-gc and level I – level II abilities. In Cattellian terminology measures like RPM and verbal Creativity through Holtzman Test 155

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Sternberg, R.J. (1988). The nature of creativity (Eds). Cambridge : Cambridge University Press. Sternberg, R.J. (1996). Successful Intelligence. New York: Simon and Schuster. Sternberg, R.J. (1999). A propulsion model of creative contributions. Review of General Psychology, 3, 83-100. Sternberg, R.J. (1999). Handbook of creativity. New York: Cambridge University Press. Sternberg, R.J. (2003). Wisdom, Intelligence, and Creativity Synthesized. New York: Cambridge University Press. Sternberg, R.J. and Lubart, T.I. (1991). An investment theory of creativity and its development. Human Development, 34(1), 1-32 Sternberg, R.J. and Lubart, T.I. (1995). Defying the crowd: cultivating creativity in a culture of conformity. New York: Free Press. Sternberg, R.J. and Lubart, T.I. (1996). Investing in creativity. American Psychologist, 51(7), 677-688. Sternberg, R.J., Conway, B.E., Kerton, J.L., and Bernstein, M. (1981). Peoples conceptions of intelligence. Journal of Personality and Social Psychology, 41, 37-55. Torrance, E.P. (1975). Some guiding principles in evaluating excellence. Creativity Newsletter, 1-10. Torrance, E.P., & Alliotti, N.C. (1969). Sex differences in levels of performance and test-retest reliability of the Torrance tests of creative thinking. Journal of Creative Behaviour, 3, 52-57. Wallach, M.A. & Kogan, N. (1965). Modes of thinking in young children. New York: Holt Rinchart and Winston. Weisberg, R. (1986). Creativity, genius, and other myths. New York: Freeman. Weisberg, R. (1988). Problem Solving and Creativity. In R.J. Sternberg (Ed.), The nature of creativity. New York: Cambridge University Press. Weisberg, R. (1993). Creativity: Beyond the myth of genius. New York: Freeman. Weisberg, R.W. & Alba, J.W. (1981). An examination of the alleged role of “fixation” in the solution of several “insight” problems, Journal of Experimental Psychology: General, 110, 169- 192. Yamamoto, K. (1964). Threshold of intelligence in academic achievement of highly creative students. Journal of Experimental Education, 32, Yang, S.Y. & Sternberg, R.J. (1997). Taiwanese Chinese people’s conceptions of intelligence. Intelligence, 25, 21-36. 160 Singh

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