SIS Journal of Projective Psychology & Mental Health

ISSN 0971 - 6610 SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH The Official Publication of the Somatic Inkblot Society Volume 15 Number 2 July, 2008

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, Dept. of Clinical Psychology,RINPAS,Kanke,Ranchi-834006. E-mail:editor_sis@rediffmail.com & sisamool@yahoo.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 $50 for foreign members and Rs. 300, for Indian members, Institutional subscriptions are US $100. for Foreign institutions and Rs. 1000 for Indian institutions. Life membership is US $400 for foreign members and Rs. 2500/- for Indian members. Indian institutional life membership is Rs. 10,000/-. Non-members may subscribe for $60 or Rs. 250 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 $10/ Rs.50/- if you are sending subscription through cheque. CHANGE OF ADDRESS. Society/journal members should inform B.L. Dubey Ph.D, Director SIS Centre, Email : sisdubey@rediffmail.com of any change of mailing address. Copyright @ 1994. SOMATIC INKBLOT CENTRE, India/ Anchorage U.S.A. Website: http://www.somaticinkblots.com

SIS Journal of Projective Psychology & Mental Health Volume 15, Number 2, July 2008 Contents Page Nos. 1. Editorial: Blending SIS Concepts in Treatment with Virtual Reality Technology 91-94 Wilfred A. Cassell 2. Presidential Address: SIS as a Therapeutic Time Machine for the 21st Century 95-102 Bankey L. Dubey 3. “The Mutilated Breast Syndrome” -SIS Augmentation of Psychotherapy in Postpartum Onset OCD 103-112 Walter A. Case and Bankey L. Dubey 4. Characteristics of Subjects Who Perceive Female Figure on Card VII of Rorschach Test 113-117 S. K. Singh, R. K. Singh, D. K. Singh and Jai Prakash 5. Diagnostic Efficiency of New Rorschach Depression Index (DEPI) 118-127 Lissy George and Ranjeet Kumar 6. Personality Differences between Treated and Non Treated (Charas) Dependence Cases 128-133 Vandana Sharma, Awadhesh Upadhyay and M. G. Sharma 7. Rorschach Profile of Neurotic Patients 134-144 Shakti Mishra and M. P. Gupta 8. Effect of School Environments on SIS-II Percepts 145-151 Umed Singh and Naseeb Singh 9. Psychological Defenses used by the Substance Dependents 152-156 Nawab A. Khan, Masroor Jahan, Amool R. Singh and K. S. Sengar 10. SIS –II Profile of Alcohol Dependence Patients 157-162 Jay K. Ranjan, Anju Kumari, Dolly Kumari, Jai Prakash and K. S. Sengar

SIS Research Award The editors and editorial consultants wish to express their sincere appreciation to Prof (Dr) Amool R. Singh for his insightful and dedicated leadership who has provided dynamic spectrum and untiring efforts for improvement of quality and timely publication of our Journal. We wish to announce his selection for this year’s Research Award of one thousand dollars. Also to be praised is the behind the scenes supportive efforts of his wife Dr Archana Singh for her impressive contribution for the advancement of the SIS Journal. 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 Centre 4501 E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E mail: siscassell2@yahoo.com

Editorial Blending SIS Concepts in Treatment with Virtual Reality Technology Severe psychological stress in childhood can set the stage for a variety of psychiatric disorders. In this journal a clinical case study entitled “The Mutilated Breast Syndrome” illustrates this phenomenon. It describes the use of the SIS-II in the psychotherapeutic treatment of a woman whose stress induced childhood psychobiological injuries subsequently surfaced symptomatically in adulthood as Obsessive-compulsive Disorder with Comorbid Major Depression. In recent years the biological roots of this childhood phenomenon have been uncovered by multilevel scientific studies. Concerning the genetic level, it has been found (Caspi et al, 2003) that individuals with the s allele of the promoter region of the SERT gene (SLC 6A4) are particularly vulnerable to the depressogenic effects of early life stress (i.e. child abuse or neglect ). Consistent with the incremental potency of these genetic determinants, two copies of the s allele has been shown to increase this genetic vulnerability to latter life depression. In a related fashion, it has been observed that severe stress has the capacity to trigger a variety of medical illnesses. For example, with regard to cardiovascular disease, stressors are approximately equal in toxic influence to long recognized predisposing biological factors such as cholesterol abnormalities, obesity, tobacco smoking etc. Multiple studies have established primary pathophysiologic mechanisms mediating stress such as the hypothalamic-pituitary-adrenal axis (Helm et al, 2000). A promising area of recent research has studied the deleterious effects of stress on the immune system (Miller & Raison, 2008). Research related to the pharmacological action of psychotropic drugs, continues to uncover an ever expanding sea of stress mediating neurotransmitters related to serotonergic, noradrenergic and dopaminergic systems as well as many others. What appears to be the essence of the extensive work in the field are the following considerations: (1) Genetic vulnerability (2) Childhood stress sets the “Thermostat” in the brain for a higher level of baseline neurophysiological activity (3) When stressed, the subsequent increased level of arousal reaches much higher levels, than control subjects lacking a developmentally injured psychobiological system (4) The immune system may be involved (5) Multiple neurotransmitters mediate effects. As drug manufactures target specific genetic defects in neurochemical transmission, clinicians may expect a tremendous growth in new and hopefully more effective treatment agents. These should make the outlook much more positive for managing a wide range of psychiatric conditions. Yet to date, when psychopharmacological efficacy has been examined in the harsh scientific light of placebo controlled clinical investigation, what has emerged from the double blind statistical analyses has been sobering. For example, with regard to treatment outcome in depression, the rate of remission in acute monotherapy trials with SSRIs and SNRIs has been lower than predicted (ranging from 28% to 45%) (Trivedi et al 2006).

92 Cassell Moreover, most treated patients with depression still suffer from residual symptoms and 10-20 % are refractory to all conventional therapeutic modalities currently available, including electroconvulsive treatment (Miller & Raison, 2008). Consequently there continues to be an important place for combining medication management with SIS image assisted Cognitive Psychotherapy. Realistically such therapeutic attempts may sometimes seem like swimming upstream against the strong overriding pathophysiologic currents, because stress based memories are so indelibly recorded in the brain of the various psychotherapeutic forms, perhaps the most comprehensively scrutinized under carefully controlled conditions has been Cognitive Psychotherapy. In sharp contrast, while this journal has reviewed the use of SIS technology as a promising treatment aide in a variety of psychiatric conditions, there have been no comprehensive attempts to implement a statistically based outcome study. This is surely needed. Without this, it is likely that our innovative pioneering efforts will be assigned the backwaters of psychiatric treatment history. Our ongoing lack of sufficient research funding continues to contribute to this deficiency. With regard to Posttraumatic Stress Disorder (PTSD), the SIS may have already been bypassed by the image generating projective power of interactive virtual reality. Currently the United States Department of Defense has funded a major program in assessing the treatment virtues of virtual-reality programs. The initial ground work for this was laid in 1997, twenty years after the Vietnam War (Halpern, 2008). It did not involve “Ambiguous Inkblots” like the SIS, but rather a contrived Virtual Reality combat situation mimicking battle stress. In the initial pilot study, ten veterans with long-term PTSD that had not responded to previous therapeutic interventions participated for a period of one to two months duration. All showed improvement initially and in a one year follow-up appraisal. Such exposure therapy or immersion therapy is designed to “Habituate” or “Recondition” the deranged neural networks in the brain. Theoretically it disconnects the cognitive aspect of PTSD memory from the stress related affect and underlying pathophysiologic memory processes. Similar methodological principles apply for the use of the SIS-II video and computer monitor versions. However with the current SIS system, selecting the stressful imagery or response rated as “Most disliked” out of the 62 test items has conceptual advantages. It facilitates a sharper focusing on the traumatic memories . This sets the stage for their immediate desensitization by floral imagery.. Conceptually, bringing this anxiety-charged imagery into visual focus at a psychological level, concurrently activates the pathphysiological processes underlying stressful memories. In this time sequence, the neurochemicals associated with the “After Image” are likely most vulnerable to being washed out by reconditioning ones released by calming nature scenes. This simultaneous temporal association facilitates the reconditioning of the brain.

The importance of selecting the most threatening SIS imagery for therapeutic processing has a supporting and relevant background. One example of the investigated constructs in the conceptual model concerns neuroimaging research, regarding anxiety disrupted patterns of “vigilance for threat” (1-4).It appears that the underlying mechanisms may be anatomically based in a neural circuit that includes the amygdala and the ventrolateral prefrontal cortex (Bradley et al, 1999, Mogg et al, 1995, Mogg et al, 2000, Monk et al, 2006). Relevant to the use of ambiguous visual input, as a research technique analogous to projective stimulation with the SIS, are investigations using masked threatening faces (Armory 2005, Rauch, 2000, Monk et al 2008). Recently I have been experimenting with a new series of image generating stimuli designed to activate specific real life traumatic situations giving rise to stress based memories. This experimental SIS series begins with alcohol and street drugs scenes replicating chemically addictive ways that PTSD victims self medicate in order to obtain relief from their disturbing recurrent imagery. Subsequently the series is heavily loaded with scenes relevant to law enforcement and military stress. The last few ambiguous “pictures” depict explosions. The final one is a portrayal of an military tank firing. Unlike USA government funded research use of virtual reality, the SIS technique attempts to identify the specific stimulus which most accurately brought to mind the earlier stressful memories (e.g. Imagery evoked by SIS 27A in the “Mutilated Breast Syndrome” article on page 103). Designing a custom made visual program, then enables the operator to therapeutically work with this by repetitively following the most threatening imagery with relaxing brain reconditioning nature scenes. Perhaps this ongoing and evolving approach may reflect a step forward in computer controlled SIS treatment. Future plans call for blending current SIS theoretical concepts and technology with patient/ client specific stress replicating virtual reality image generating interactive machines. If appropriate research funding is obtained, the new technology will incorporate as projective stimuli various additional sensory input modalities. Perhaps then, the diagnostic applications of the SIS might be surpassed by the blended system’s therapeutic potential. References Armony JL, Corbo V, Clement MH, Brumet A. (2005); Amygdala response in patients with acute PTSD to masked and unmasked emotional facial ex-pressions. Am J Psychiatry,162(10): 1961-1963 Bradley BP, Modg K, White J, Groom C, de Bono J. (1999); Attentional bias for emotional faces in generalized anxiety disorder. Br J Clin Psychol, 38- (pt 3) : 267-278 Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R. (2003); Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301: 386-389 Halpern S: Virtual Iraq. (2008); The New Yorker May 19th 2008 : 32-37 Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB. (2000); Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA, 284: 592-597 Blending SIS Concepts 93

Millar NH & Raison, C.L. (2008); Immune system contributions to the pathophysiology of depression. Focus, Volume VI, Number 1: 36-45 Monk CS, Nelson EE, McClure EB, Mogg K, Bradley BP, Leibenluft E, Blair RJ, Chen G, Charney DS, Ernst M, Pine DS (2006); Ventrolateral prefrontal cortex activation and attentional bias in response to angry faces in adolescents with generalized anxiety disorder. Am Jr Psychiatry, 163(6): 1091-1097 Monk CS, Telver EH, Mogg K, Bradley BP, Mai X, Louro HMC, Chen G, Mcclure-Tone EB, Ernst M, Pine, DS (2008); Amydgala and ventral lateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Arch Gen Psychiatry, 65(5): 568-576 Mogg K, Bradley, BP, Millar N, White J, (1995); A follow-up study of cognitve bias in generalized anxiety disorder. Behav Res Ther, 33(8): 927-935 Mogg K, Millar N, Bradley BP. (2000); Biases in eye movements to threatening facial ex-pressions in generalized anxiety disorder and depressive disorder. J Abnorm Psychol, 109-(4): 695- Rauch SL, Whallen PJ, Shin LM, McInerney SC, Maclin ML, Lasko NB, Orr SP, Pitman RK (2000); Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: functional MIR study. Biol Psychiatry, 47(9): 769-776 Trivedi MH, Rush AJ, Wisniewdski SR, Niereneerg AA, Warden G, Ritz L, Northquist G, Holland RH, Lebowitz Z, McGrath PJ, Shords-Wilson K, Biggs MM, Balusbrumami GK, Fava M (2006); STAR* D Study Team: Evaluation of outcomes with citalopram using measurementbased care in STAR*D: implications for clinical practice. Am J Psychiatry, 163:28-40 Wilfred A Cassell, M.D., FAPA, APC. Director, SIS Center, Editor Emeritus, SIS Journal, 4501E, 104th Avenue, Anchorage, Alaska - 99516 (USA). E-Mail : siscassell2@yahoo.com 94 Cassell

Presidential Address Presented in the 6th International Conference of Somatic Inkblot Society, held at Ranchi Institute of Neuro Psychiatry and Applied Sciences (RINPAS), Kanke, Ranchi (India), Feb. 9-11,2008 SIS as a Therapeutic Time Machine for the 21st Century Respected Chief Guest Prof. A.A.Khan, Vice Chancellor, Ranchi University, Prof. N.N. Aggarwal, Director RINPAS, Maj.Gen. K.R.Banerjee, Former Director, RINPAS, Patron Dr. Wilfred A. Cassell, Founder of Somatic Inkblot Society(SIS), Prof. Amool Ranjan Singh, Organizing Secretary of the 6th SIS International Conference, Prof. Col. Suprakash Chaudhury, professional friends and students of RINPAS, Members of Organizing Committee, Office bearers of Somatic Inkblot Society, delegates, ladies and gentleman! On behalf of the members of the Organizing Committee of 6th SIS International Conference, Somatic Inkblot Society and on my own behalf, I express deep sense of gratitude to the well wishers for helping in organizing this Conference. It is customary that the President of the Association delivers an address on such an occasion. Accordingly, I have the privilege of addressing this august body. The theme of the conference is “Personality Assessment, Diagnostic Evaluation and Therapeutic Intervention. This conference becomes more important because it is being held at one of the two premium Institutes of Psychiatry and the largest Mental Hospital in India. The other important reason is to celebrate 100 years of the publication of Clinical Psychology Journal started by Lightner Witmer in 1907. We welcome and thank you for attending this 2008 meeting of the SIS Society. Unfortunately Mary Cassell’s health again prevented Dr Cassell from attending. Although not physically present, he assured me that he continues to be with us in spirit. Prior to my leaving Alaska we discussed the history of the SIS in regard to it evolving into plans for transforming it into a projective form of robotic artificial intelligence. Let us begin this meeting by dedicating our communication style to high standards of objective evidence based investigation. Moreover we also give tribute to time honored methods of subjective introspection, such as illustrated by the masters of Yoga meditation. Look forward to an intellectual feast blending the optimal aspects of these two approaches. I now invite you to shut your eyes and meditate with a reverence for the many mysteries of life. Imagine that we all are in an outdoor amphitheatre surrounded by beautiful fragrant flowers. Breathe deeply and slowly, letting tension flow out with each expiration. Feel your muscles relax. Let your mind free itself of all worldly tensions, negative thoughts and professional jealousies.

Now imagine a healing beam of positive spiritual energy transiently focusing on your forehead and gently passing into your brain. Experience it as a mysterious spiritual stream revitalizing you in body, mind and spirit. Sense it erasing any residual inner world suffering empathetically acquired from past professional exposure to potentially toxic traumatic SIS imagery or other stressful life events. Recognize that like all life forms on this planet we are mere mortals and fragile. All of us exist in a time limited physical shell encompassing trillions of dancing inanimate atoms. Imagine that at this meditation these structural elements from all of us become transiently fused in an optimal energizing fashion. Visualize a loving dancing pattern maximizing the ability of participants to communicate during this important SIS meeting. For a few private moments enjoy this inner world cleansing and bonding experience. At this time I would like to take this opportunity to express sincere appreciation for all who have contributed so much to our journal. I express my sincere appreciation to Prof. Amool R.Singh and his wife Archana Singh, Col. Prof. Suprakash Chaudhury, Dr. Jai Prakash and Members Editorial Board for their untiring effort for timely publication of our Journal. Now I would like to share our plans for the future. The various SIS systems may be conceptualized as an innovative form of artificial intelligence for activating projective images in consciousness. In the 21st century these original systems will be modified incorporating state of the art computer based internet technology. We plan to intellectually cross fertilize SIS concepts with those in the field of robotic artificial intelligence. Through modern engineering and electronics, the robotic offspring of this union likely will lead to many unforeseen applications in epidemiology, medicine, psychology, education and space travel. Perhaps it might be of historical interest to this society for me to review about our background thinking regarding the value of a marriage between SIS electronic imaging technologies with those of artificial intelligence. According to the Wikipedia internet search engine the dawn of this now rapidly expanding field began in 1950 when Alan Turing built a machine designed to participate in human-like conversation. The next year a rudimentary chess playing program was written by Dietrich Prinz. Ultimately in 1997, reflecting the growth of knowledge in the field, the Deep Blue chess machine from IBM was able to beat the world chess champion, Garry Kasparov. The term Artificial Intelligence (AI) was introduced in 1956 by John McCarthy to mean “The science and engineering of making intelligent machines”. This preceded by three years Dr Cassell’s first clinical investigation on the “Body Image”, which led him to design inkblots with somatic color-form content. In order to initially evaluate their validity, he evaluated subjects with medical histories which included regionally specific somatic symptoms. Since this early work, several studies have supported the validity of this projective procedure. In the early 1960’s Dr Cassell collaborated with George Stern, a professor of psychology at Syracuse University, whose room sized computer provided him an early machine form 96 Dubey

of artificial intelligence. Dr Stern had developed a machine scored questionnaire based program for assessing attitudes in a student population in excess of 5000. Wilfred included a medical history form for identifying subjects who experienced regionally specific psychophysiologic symptoms. One data analysis program that might be of interest to practitioners of Yoga was as follows: it was discovered that symptom based focusing of body awareness attention on outer areas (e.g. skin and skeletal muscle) was statistically correlated with symptom reduction on inner regions (e.g. heart and stomach). In 1964 he moved to Saskatchewan, Canada where he had computer access to the computer based medical records of a population of over a million. At that time, it was the most advanced electronic data processing system in the world. His research team completed several studies which consistent with the basic concepts of artificial intelligence in medicine and epidemiology. Several years later he moved to Alaska. While doing a presentation on the original 20 Card form of the SIS at a meeting of the American Psychological Association in 1982, he came across a new opportunity. He met representatives of a computer company in Kansas City who were marketing a computer system called a Psychometer for administering and scoring psychological tests such as the MMPI. The subject was presented a series of questions and responded on a specially designed keyboard “Yes” or “No”. Upon completion of testing the computer was programmed to automatically compare answers with pre-programmed normative data. Results were immediately computed and made available in graphic fashion, along with statistically based diagnostic probability statements. Since the idea of artificial intelligence fascinated him, he purchased a Psychometer for his clinical practice in Anchorage. It soon became apparent that many people preferred interacting with a computer, more than traditional paper and pencil tests. The system was portable so that it could be taken to a hospital room. Moreover it provided immediate clinically helpful data. Consequently with the financial backing of an Alaskan bank, he set up a company in order to place a computer in Vancouver Canada, Portland Oregon and Honolulu Hawaii for nonprojective testing. His goal was to concurrently develop an electronic form of the SIS within this corporate structure beginning with video technology. His long term goal to eventually transfer the SIS electronic images to a computer robotic system. For a few years this plan appeared to be promising. However, he told me that he was naïve in regard to business. Consequently the upstart company ran into serious obstacles – legal, technical, and economic. An example of a legal problem follows: Without his knowledge, the government of British Columbia took funds from a test level psychologist position to pay for the Psychometer. When the provincial psychological association learned of this, they threatened to sue his economically fragile company. Concurrently technical advances in computers also paved the way for a number of more cost effective psychological assessments. Many clinicians were becoming computer literate using systems purchased at a fraction of the cost of Psychometers ($25,000). Since this SIS as a Therapeutic Time Machine 97

became general knowledge in computer circles, eventually Bill Gates in Seattle learned of this new revenue source. Microsoft then purchased the Kansas City Psychometer Company, along with the copyrights for lucrative tests such as the MMPI. These events led to the collapse of his original company. The resultant economic stresses caused the postponement of his plans. Yet his vision for developing a cost effective clinically useful SIS robotic consultant continued to grow. We both invite members of our SIS Society to take up the challenge. During the meeting which follows I encourage you to consider this against the light of our many past SIS accomplishments. Envision incorporating in future projects computer based robotic technology related to image recognition and analysis. A few of the reasons that this should prove a promising course follow: (1) The procedure’s administration requires explanation of the risk/benefits by a licensed mental health professional but afterwards the subject interacts with the SIS “Robot” totally alone. (2) Initially the SIS “Robot” provides auditory and visual sensory input to the participant’s brain. This process is conceptually analogous to that traditionally used in the induction phase by human hypnotists. The video and computer systems initial phase involves viewing beautiful floral photographs. These are accompanied by a sound tract with suggestions to “Relax, take a few deep breaths and let your mind free itself etc”. This artificially induces a trance like hypnotic mental state. During this mental defenses are bypassed mentally transporting the viewer to earlier life situations thereby releasing stressful memories. In this conceptual model, the robotic system functions in a manner that a science fiction writer would likely call a “Time Machine”. (3) Next for teaching purposes the “Robotic instructor” presents a visual-auditory segment, illustrating an example of a subject responding to an inkblot. In its present 1986 developmental state, the auditory input also includes instructions on how to write responses on an answer sheet having outlines of the 62 item SIS visual stimuli.. Theoretically this serves a similar purpose to hand writing records in traditional hypnotic trances. In clinical practice this affords the hypnotist the opportunity for the subsequent detailed analysis of otherwise verbally unreported subjective experiences during the trance. Frequently what is written reflects what the responder would prefer not to express directly to another human, because of concerns about social acceptability. In addition, in certain clinical conditions such as the Dissociative Disorders the writing may depict in disguised symbolic form perceptions and memories for which the subject is totally amnesic. A long standing goal of Wilfred’s has been to develop computer programs capable of replacing the paper answer sheet recording methodology. (4) After the state of altered awareness is artificially induced, the projective stimuli that were originally built into the SIS-II system are immediately electronically 98 Dubey

activated. Following each of the 62 stimuli, one of the original floral photograph series is repeated by the SIS “Robot” to neutralize any resultant emotional discomfort and to further deepen the trance. This is quite analogous to soothing suggestions that a human hypnotist might make under similar conditions of anxiety arousal. After the series there are presentation restorative nature scenes and sounds. (5) Upon completion of the viewing the subject rates what is seen and emotionally experienced on a scale by indicating the three “Most liked” images and the three “Least liked” ones. Usually the latter are of more clinical significance. In 1991 it was first learned that sometimes these can reflect an emergence from memory storage of Posttraumatic Stress Disorder (PTSD) dream imagery. In this sense the system was found to operate in a fashion, which the Alaskan Native people would refer to as a robotic “Dream Catcher”. Perhaps you may recall from our journal that the first case involved a law enforcement officer. He was able to reprocess a stressful accident scene witnessed fifteen years earlier. He found that rethinking what happened removed from the original stressful conditions clarified old confusing thoughts and released pent up emotions. He reported that he benefited just from the viewing opportunity without professional intervention. In this way the SIS “Robot” functioned like a human cognitive psychotherapist. (6) Since calming nature scenes and relaxing music are presented immediately during the after glow of released PTSD imagery for psychophsiologic reconditioning, the system can also act like a robotic behavioral psychotherapist. Repeated viewing under gradually lowering levels of arousal can reduce the hyperactivity habitually triggered by cues reminiscent of the original stressful events. The clinician may elect to repeat the series until gradual extinction of abnormal responses underlying psychophysiologic somatic symptoms (e.g. “Palpitations”) occurs. This is cost effective since the administrator need not be present during repeated viewing session. Developing Future SIS Technology : The present 1986 series of 62 images provides a powerful visual stimulus series for activating from memory storage PTSD imagery. However, it was not designed originally to do so. As previously indicated, this was an original clinical finding in evaluating a traumatized law enforcement officer. Given this unpredicted observation as well as years of clinical experience in stressed subjects, it seemed logical to take a further step. This involved designing an additional series with specific structure relative to stressful events that Dr Cassell labeled “Memories”. These images were recorded in a DVD mode in order to incorporate the additional benefits of computer monitor technology. The series begins with pictorial content related to common chemical dependency problems. It moves on to include early childhood traumatic scenes SIS as a Therapeutic Time Machine 99

involving adults. Other structured “Inkblot” content portrays a variety of stressful memories - including those related to sex and violence. Consistent with the latter, the DVD ends with ambiguous scenes suggestive of a military tank, explosions and human bodies burning etc… etc… Prior to the debriefing session, the computer system enables the administrator to review the released responses. The trained clinician can then intelligently select those released projective PTSD images previously judged to be most etiologically relevant. Subsequently on the basis of the evoked projective data, this enables the design of a custom made and time efficient treatment plan. Just as the video technique, this necessarily involves psychotherapy and brain reconditioning with relaxing nature scenes. Sometimes as well psychotropic medication may be included in the treatment plan. (Possibly relevant to this are animal research studies. These suggest that the administration of propanolol during exposure to stress may alter the chemical processes related to memory storage. Future brain scientists might consider stimulating with “Memories” the release of PTSD neurochemicals for chemical assay. Conceivably this might set the stage neutralizing their toxicity with newly designed propanolol like psychopharmacologic agents.) Warning! There is an occupational hazard! Like all versions of the traumatic memory releasing SIS - but even much more so - this exposes the sensitive psychotherapist to “Empathetic” or “Secondary” PTSD. Futuristic SIS Technology : Scientific and technologic advances are rapidly expanding the human potential for living on nearby planets. Developments in DNA alteration are enabling some geneticists to predict the future in almost a science fiction fashion. One such futuristic fantasy recently outlined in a popular science magazine might be briefly considered. The author’s fantastic plan involved genetically redesigning and empowering the future astronaut’s nervous system. The second step involved repackaging the pulsating neural tissue in a modified body more suitable for space travel. Of course this prediction may seem mind boggling. Wilfred and I challenge you to redesign our SIS projective technology as robotic aides for futuristic endeavors .There is a common link between our projective field and such futuristic genetically related body-mind predictions. In a more realistic fashion, the hypnotically introduced semi structured visual stimuli can alter neural activity. Even in its original 1986 primitive state, the SIS robot can activate from memory storage several different types of imagery. These can stimulate recalling real life visual scenes, imagined or fantasized mental pictures, night time dreams, day time visual PTSD flashbacks, visual hallucinations from mental disorders, toxic alcohol or drug induced psychotic states and so on. In clinical situations, it has been shown in repeated case studies how this activation can have both diagnostic and therapeutic applications. Theoretically it also could have values in space research. For example, in spite of interviews and standard psychological testing, American astronauts have manifested troubling problems. Recall the media stories in 2007 of a violent love triangle in one instance. In another, 100 Dubey

members scheduled for a flight showed up intoxicated. Unfortunately in the United States, where concern about personal freedom frequently trumps safety and public health issues, SIS screening is bypassed. Yet I have personally found this SIS application highly useful in Indian industrial settings - and still ethical. Because of its electronic form, the SIS may be transmitted millions of miles through space. This could enable the earth SIS trained ground coordinator to evaluate and if need be to alter the genetically redesigned astronauts’ body-mind functions. Imagine the possible benefits it this individual could somehow apply the historic knowledge of Yoga meditation enriched by futuristic SIS robotic technology. Consider the possible benefits of slowing down vital physiological functions of respiration and heart rate for a long space voyage. Conceivably this might enable the DNA modified “Human?” physiological package to hibernate - like a brown bear during a long Alaskan winter. The present video and computer monitor versions of the SIS only utilize visual and auditory input. I invite you to imagine future systems evolving into a humanoid appearing mobile robot with language recognition capabilities. Imagine the value of supplementing visual stimulation with additional forms of sensory input such as touch and smell. For example in regard to the latter, the sense of smell is connected neurologically to the neural centers related to emotions. As a projective source of stimulation, this sensory input could have unforeseen clinical applications. In evaluating psychotics, many suffering from Schizophrenic Disorder have olfactory hallucinations, yet this clinical information is frequently over looked. Adding this component to robotic stimulating technology also could serve to place the therapeutic field of Aroma therapy on a more discriminating and scientific basis. I hope that all in attendance consider taking up such technologically feasible futuristic challenges. We live in an ever changing world. The only constant appears to be the persistence of change itself. Lets us avoid being stimulus bound like the archaic Rorschach. While innovative and giant steps forward, please do not become “Locked in stone” with any of the present forms of the SIS. Conceptually move towards incorporating SIS multiple sensory stimulating techniques with ongoing developments in robotic intelligence. We also hope in future, the beneficial effects of SIS would be available to the patients residing any where in the world through Tele-therapy. A therapist while sitting in his clinic in another part of the world can still provide therapeutic aid to such a person through this modern technology. Such a network will help us in sharing the human sufferings in different cultures and further searching a way to improve human lives. Thank you for your help and support. Bankey L. Dubey, Ph.D., DMSP, DPM. President Somatic Inkblot Society, Director SIS Center, 4406 Forest Road, Anchorage, AK 99517(USA) E-mail : bldubey@gmail.com SIS as a Therapeutic Time Machine 101

References : Cassell, W.A. (1964); A Projective Index of Body Interior Awareness, Psychosomatic Medicine, 26:172-177. Cassell, W. A. (1994); The Somatic Inkblot Series: Continuing Rorschach’s Conceptualization. Cassell, W.A. and Dubey B.L. (2003) Interpreting Inner World through Somatic Imagery, SIS Centre, Anchorage, (USA). Freud, S. (1950); Further Remarks on the Defense Neuro-Psychoses (1896), Collected Papers, Vol. I, Hograth Press London, pp. 155-182. Holtzmann, W.H. (1956); Inkblot Perception and Personality, University of Texas Press, Texas. Murstein, B. I. (1995); The Relationship of Stimulus, Projection and Pathology in Projective Techniques and the “Levels Effect”. SIS J. Projective Psychology and Mental Health, 2:41-52. Rapaport, D., Gill, M.M. and Schafer, R. (1968); Diagnostic Psychological Testing, International Univer Press Inc., NY. Rorschach, H. (1921); Psycho diagnostic, Ernst Bircher. 102 Dubey SIS Instruments can be Obtained from : Somatic Inkblot Center 4501E, 104th Avenue Anchorage, AK.99516 (USA) E-Mail: siscassell@yahoo.com & Somatic Inkblot Center 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail:sisdubey@rediffmail.com

psychotherapy. Content analysis of SIS projected symbolic imagery was able to bring to the surface longforgotten, unresolved stressors. The SIS could stimulate in memory long forgotten posttraumatic dreams and providing clinically relevant information for treatment plan. The SIS therapeutic intervention can be implemented to undermine affect linked irrational obsessions and thereby reduce compulsive behaviors. Mental symptoms in Obsessive Compulsive Disorder (OCD) involve the obsessive flooding of consciousness with irrational thoughts and pathological images. These lead to compulsive repetitive behaviors and mental activity subjectively calculated to reduce inner tension. Affect storms, encompassing anxiety, irritability and depression, motivate the sufferer to seek treatment. Such an individual ordinarily recognizes that the unrealistic thoughts and compulsions are symptoms of mental disorder. This recognition represents an important stepping stone for the clinician and the patient/ client to begin jointly planning a comprehensive treatment program. Cognitive behavioral psychotherapy in controlled studies has been shown to be highly effective and estimated to be one hundred percent more so than psychopharmacologic medication. Unlike the latter, upon termination of treatment, the therapeutic benefits tend to persist over time. Since the condition is often resistant to therapeutic intervention, long term strategies may be required. In severe protracted cases proven to be resistant to standard therapies, neurosurgery, designed to obliterate neural tracts underlying the OCD symptoms has been shown to be effective. There has long been an interest in considering the possible cultural influences in OCD (Fontenelle et al, 2004, Hollander et al, 2007) Yet in many separate studies, factor and cluster analyses have provided convincing evidence of distinct OCD symptom dimensions accounting for 65.5 % of the variance in outcome: contamination/washing, hoarding, sexual/ religious obsessions, doubt/checking, and symmetry/ordering (Baer et al, 1994,Leckman et al, 1997, Mataix-Cols et al, 1999, 2005, Summerfeld et al, 1999). In line with this, a recent Japanese study emphasizes their consistency across cultures and points to the need for neurobiological research to uncover underlying mechanisms (Matsunaga et al 2007). It has been established that the stress of pregnancy in women is associated with anxiety and depressive disorders (Heron et al, 2004 and Ross and McLean 2006). Relative to OCD, fifty percent of adult-onset cases begin in the postpartum period (William and Koran 1997). In terms of genetic theory, it has been postulated that this condition may reflect a deviant form of altruism or maternal love resulting from a stress exaggerated deregulation

of the brain circuits underlying detecting threat (Feygin et al. 2006). Somatic Inkblot Series (SIS) : This case history presentation illustrates the use of the Somatic Inkblot Series (SIS) as an aide in cognitive behavioral psychotherapy for adult onset OCD related to pregnancy. The SIS projective technique capitalizes on the principle that in communication, “ A picture is worth a thousand words”. Content analysis of SIS projected symbolic imagery can clarify the historical reality of long-forgotten, unresolved stressors. In addition to defensive memory inhibitions, frequently, for reasons of social acceptability, these are difficult for the traumatized victim to verbalize in face to face interviews. Reviewing the significance of the SIS symbols can by pass psychological defense that can block the free expression of disturbing emotions. Moreover it has been shown that the SIS can stimulate in memory long forgotten posttraumatic dreams. Incorporating this information into the treatment plan can enrich cognitive behavioral psychotherapy. New strategies can be implemented which can more effectively undermine affect linked irrational obsessions and thereby reduce compulsive behaviors. Previous case history studies have shown how affect charged dream imagery may be projected onto structurally suggestive SIS stimuli during the altered state of consciousness induced by viewing mesmerizing flowers in the SIS-II Video. This projective process was first observed in 1991 - without interview prompting. This projective phenomenon occurred during the content analysis of a SIS video answer sheet completed by a hospitalized depressed traffic policeman. Image 2A triggered his long term traumatic memory so that he visualized a motor vehicle tragedy involving a seriously injured family. He had witnessed this years previously. Emotionally threatening images of the stressful scene for a long time had recurred in his dreams. Afterwards in the relatively relaxed conditions of SIS viewing, he began to independently correct his long standing confused thoughts and emotions. He recalled having experienced “Nightmares” depicting the scene in which images of his own children merged with those in the accident. Initially they were direct almost picturing representations. However, as “Natures natural” homeostatic healing action took place during restorative sleep, these were replaced with defensive symbolic dreams. Subsequently this newly recognized projective phenomenon linking dream material - SIS responses has been observed in a variety of stress triggered clinical conditions. Time appears to be an important variable. Imagine a conceptual model having a response assessment scale ranging at one pole, from direct pictorial depiction of the real life event, to the opposite pole, involving affect reducing disguised, defensive symbolization. The longer the duration, the more likely will be that the projected material will be concealed in symbols. Another earlier case history report in this journal outlined how a victim injured in an industrial explosion visualized an explosive scene in the television viewing of B19. His response directly replicated traumatic scenes witnessed in his dreams. These occurred during the 104 Case & Dubey

early weeks of therapy eventually with the passage of time they were replaced with defensive dream symbols. For example, these less sleep disturbing images involved observing “A minor microwave explosion”. Case History : This involves a forty four year old married woman of British origin whose obsessive compulsive symptoms first surfaced years earlier when she was enrolled in a London medical school. At that time her mind was flooded with irrational thoughts. Although she recognized these as being irrational, she could not control them. Eventually she was forced to terminate her medical training because of the severity of her mental symptoms. The immediate social stress involved a failed romantic relationship with an engineering student. The couple had been sexually active without protection and she became pregnant. After a few weeks, she had a spontaneous miscarriage. Her OCD symptoms were heavily loaded for the type that has been categorized as “Sexual/ religious” (Matsumaga et al 2008). Although her old history was vague, it appears, in retrospect, that her aggressive questioning about irrational sexual issues and guilt was too much for him. Eventually he dropped out of the relationship. Following this she became depressed, anorexic and lost weight. At that time, her condition probably met the clinical criteria for co morbid Major Depressive Disorder. Shortly afterwards her aunt, a nurse, took her to see the family physician. Apparently he did not recognize the significance of her symptoms or prescribe appropriate treatment. Moreover he neglected to refer her for a psychiatric consultation in the British health system. Eventually with the passage of time her OCD symptoms subsided sufficiently, that she was able to obtain employment as a bank teller. Her next romantic relationship was with an American businessman that she met on a Mediterranean cruise. After a short engagement they became married and she moved to Kansas. Soon she became pregnant and gave birth to an infant son. For several months in the postpartum period she continued to do well, with basically dormant mental symptoms. However at nine months when contemplating discontinuing breast feeding, her OCD symptoms intensified motivating her to seek treatment. During this second episode she shifted her sexual preoccupation to obsessive fears that her husband was “Gay”. To ensure that he wasn’t, she felt a need to compulsively have sexual intercourse almost daily. As might be expected, this compulsive behavior only relieved tension transiently. She was soon would be aggressively questioning him looking for evidence that her homosexual suspicions about him were valid. Historically these obsessions were traceable to when she was a girl. Based primarily on her mother’s motivation to help homeless children, her parents adopted a boy and two girls. It soon became apparent that these young children had serious psychological problems. However the social agency did not provide any follow-up counseling. Consistent with the aphorism that “No good deed goes unpunished”, her mother became unable to The Mutilated Breast Syndrome 105

cope with the emotionally disturbed adopted children. Relative to the OCD case under discussion, the adopted son begin to wear female clothing, and subsequently adopted a “Gay” lifestyle. Another childhood stressor provided a “kernel of truth” for later life OCD obsessions, related to child rearing and nurturing. After the adoption her mother gradually retreated from the maternal role. Her frustrations caused her to become angry and abusive towards the three troubled children. Her biological daughter attempted to provide the missing nurturance to her younger adopted mentally disturbed siblings. As a child, she was unprepared and was unable to do this. She then became fearful that that she would never be an adequate mother. After the birth of her son these irrational thoughts became incorporated into obsessive fears. The initial long term treatment plan involved cognitive behavioral psychotherapy supplemented by pharmacotherapy. The latter consisted of high dose Fluoxetine (60 mgm daily) and low dose Alprazolam for anxiety (0.25 mgm T.I.D. as required). During the first few weeks she participated in biweekly therapy sessions. As she responded to long term treatment the frequency was gradually reduced to once monthly. Eventually after twelve years she was well enough to terminate the therapeutic relationship and discontinue psychotropic medication. Approximately four years after the above noted termination, she called requesting further therapy. In the interim things had temporarily gone relatively well both in her employment and domestic life. She and her husband had successfully raised their son to become a gifted honor student. The social stressor was an impending “Empty nest”. Their son and only child planned to leave the country to attend university in Britain. In spite of her external success as a wife and mother, her inner world was flooded with childhood guilt. This appeared to partially stem from her childhood cognitive distortions pertaining to her adopted siblings. She was obsessed with the irrational notion that she was a failure as a mother’ she feared that she might have harmed her son. She now feared that not only her husband might be “Gay”, so also, her son might be. She felt a mental pressure to compulsively question her boy about his male friends. Repeated confrontations with her husband about the irrational nature of her sexual obsessions led to marital conflict. In planning treatment, a decision was made to build upon the previously established principles of psychotherapy. Linguistically introducing the symbolic language of SIS and dream symbols as communication vehicles, supplemented the limited language available in English to express emotions. Fluoxetine was again precribed and brought to a dose level of 60 mgm daily. In the initial weeks a sedating dose (150 mgm) of Trazedone was used at bedtime to reduce insomnia. Repeat SIS-II Assessment: She was given a computer disc of SIS-II as well as a SIS answer sheet. She was instructed to view SIS stimuli before bedtime, so as to stimulate from traumatic memory storage, 106 Case & Dubey

stress-specific symbolic “Nightmares”. When handed the SIS answer sheet, she spontaneously pointed to image A4 exclaiming: “that reminds me of the tornado dream that I told you about in the last session…on the one side I see the mother and on the other the infant being torn away”. (Kansas, where she lived tends to have tornados.) The dream follows: “I was sitting in a plane with my husband, looking out the window…there were tornados in the area…my husband reassured me that we would be OK…my seat belt was not done up…we were flying in Kansas and the tornados were very black…I watched in horror as a tornado pulled a baby out of the arms of a mother…people were shrieking in panic”. This dream depicted a mental picture of her imminent loss, involving separation from her graduating son, which had activated the surfacing of her Major Depression and OCD Disorder. What was pathologically relevant was her state of dissociation associated with this imagery. In witnessing the loss of the infant, she realized, that unlike the mother of the child and other passengers who “shrieked”, she felt emotionally “detached“. Of prognostic significance, this detachment recapitulated in the dream, her own dissociated affect which was bound up with her obsessive-compulsive symptoms. Her childhood acquired tendency to isolate painful affect was also symbolized in her response to A8: “A happy man in a bubble”. This isolation of emotion posed a significant resistance to psychotherapy. This is consistent with the fact that the greater the dissociation experienced by clients with traumatic memories, the more resistant are they to therapy. In this case, the challenge involved helping her in the grieving process to link images of the “empty nest” impending loss, with emotions of grief - sadness, anger etc. etc. Her preoccupation with her graduating son’s departure was also reflected in her projective response written on the SIS booklet in regard to B8: “A graduate playing with the tassel on his hat”. The next day in the image-supplemented psychotherapy session, she changed this response by correctly recognizing the SIS stimulus as “A male silhouette”. When asked to explain this transformation in SIS projected imagery, she correctly realized its symbolic significance. This facilitated further reality testing. It provided projective evidence, From Her Own Mind, that her sadness was related to her imminent “empty nest”, “Not Her Irrational Obsessions About Her Son’s Imagined Homosexuality”. Thus, because of the SIS, she was able to comprehend this and focus away from her sexual obsessions. At this point, an additional clarification of the methodology is warranted, since a clinician’s instructions are not always followed. Ignoring these, rather than completing the computer version of SIS-II as instructed, she simply wrote her impressions to the outlines of the “Inkblots” on the SIS Answer sheet. This has been referred to as the “Booklet” form of the procedure. Previously it was used to study validity. In one study relevant to this OCD case history, pregnant women projected more themes related to pregnancy, than a matched non pregnant control group. The Mutilated Breast Syndrome 107

Projected Themes: When the examiner first inspects the “SIS Booklet” data, initial attention is given to the response sequence that was subjectively rated on the answer sheet as: “Liked Least”. This has been found in repeated studies to directly expose memories of the critical past stressful events, either in direct or symbolic form. Just as in her first SIS-II video viewing years earlier, she selected Image A27. On the answer sheet she wrote the following: “One breast…not sure what happened to the other…disturbing”. Subsequently on the next day in the detailed review of this projected symbolic imagery her additional associations were as follows: “I now see two breasts mutilated…its horrible!!! like when I first saw it …I could hardly look years ago… last night I just saw one breast…its disturbing…today it is brighter…I now see two breasts…like a woman destroyed…violence!”. In conceptualizing the significance of this pathologic anatomical response, it is necessary to consider her subjective inner world during the onset of her first OCD episode. Her obsessive-compulsive problems surfaced during her stormy medical school romantic relationship, when her brief pregnancy ended in a miscarriage. Then, in her depressed mind, her bizarre body gestalt may have involved a shrinking transformation, from having full pregnant breasts, to ones of normal size. In her irrational mind, this may have symbolically seemed like breast “Mutilation”. Perhaps this earlier fragmentation of her female body image became activated during her real pregnancy, especially nine months after when her breast were full from lactation. Nursing her baby son for nine months had given her great satisfaction. In recalling this positive period in her life, her voice became tender. In sharp contrast, she became visibly distressed when describing about her sadness having to eventually give up breast feeding. While the above formulations may have accounted for the mutilated breast response, two additional symbolic determinants from childhood warrant additional more serious consideration. The one involves her loss of her own mother’s nurturing after the adopted children caused her to emotionally withdraw. The other involves her feelings of failure in childhood regarding to have been unable to successfully substitute as a nurturing mother figure for the younger adopted siblings. A projective clue in regard to solving this puzzle consistent with the above hypothetical formulations was noticed in her response to B28 “A ghost looking down”. This SIS pictorial representation was specifically designed to provide a projective measure of the viewer’s past nurturing experience with a mother figure. It’s embedded structure depicts “a loving scene of a mother holding an infant“. In contrast to visualizing a nurturing mother, a threatening “Ghost” was envisioned. This indicated that her “Mutilated breast” response was more likely related to her loss of her own mother’s nurturing, than other outlined stressors. Additional Relevant Responses : Descending in order on the SIS arousal/threat scale, she next selected B15: “Its violent…its 108 Case & Dubey

little shards of broken glass…whoever got hit with glass probably got hurt real bad!” This follows the above noted symbolization. A woman “hurt badly” depicted symbolically her own inner emotional pain, as well as the angry “violent” nature bound up by her obsessive compulsive symptoms. Losing a loved one is painful. It can give rise to socially unacceptable anger towards the person. For her, her joy in her son’s success was underpinned with unexpressed negative emotions. These may have provided energy for her irrational accusations regarding his sexuality. The third SIS stimulus having structure suggestive of a man and woman talking, (A31) was seen as “A man an woman talking”. Subsequently, she imagined that they were in intense conflict. In her present married life, there, naturally, were arguments between her and her husband about her obsessions. In psychotherapy, she also connected these to childhood memories of her parents fighting about care of the adopted emotionally disturbed children. Her written description of A4 also depicted her ongoing inner tension and irritability. Remarkably enough, it significantly differed from the “Tornado” imagery, originally spontaneously projected, when first handed the answer sheet. Later at home she wrote: “1. The silhouette of a man with a raised fist on left…not sure about the figure on the right”. Other SIS responses were consistent with those visualized years before in the postpartum phase. They signified an ongoing preoccupation with pregnancy, starting in her failed relationship in medical school: B1 “Sea sponge…end of fallopian tube”, B12 “An egg migrating down the fallopian tube” and B21 “Fallopian tube”. She was entering the menopause and was experiencing some regrets about only having had one child. Interestingly enough, her response to B18 brought memories of sexual problems experienced with her boyfriend in nursing school. The structure embedded in this SIS stimulus array involves a phallic structure inside a vaginal like structure. On the answer sheet, she wrote “No idea…something traveling down a strange-shaped tunnel”. Next day in the detailed enquiry, she indicated that she had always disliked this SIS inkblot. Subsequently she added “Last night I didn’t see it but today I see a penis”. Next she spontaneously began talking about sexual issues in her medical school romantic relationship: “The other guy ejaculated quickly…I didn’t like that…I feared that he wasn’t turned on by me etc. etc.” An occasional recurrent disturbing dream reflected that fact that she still had not fully grieved his loss. These portrayed him with her ex girlfriend whom he had subsequently married. When giving associations to B18, she expressed concerns about acting out her own latent homosexual impulses. These involved experiencing attraction, with a degree of sexual arousal, in relation to an older, professionally successful woman. In therapy, she acquired insight regarding how, just like in projecting onto inkblots, she projected some of these concerns onto the social image of both her husband and son. This helped her to partly understand her sexual projections, but there was no obvious reduction in their persistent nature. (So-called “insight” has never been as therapeutically effective in OCD as the early The Mutilated Breast Syndrome 109

psychoanalysts had claimed. Once established, obsessive-compulsive symptoms sometimes appear to have a persistent existence of their own.) Finally, it might be noted that several responses depicted heightened awareness of the head:A11 “A lion’s head”, B7 “A girl’s head with an idea showing”, “A football helmet”, B25 “The head of a black dog” and B29 “The right and left hemispheres of the brain”. This focus of attention reflects the fact that individuals suffering from OCD are preoccupied with their obsessive thoughts, and as a result have increased brain awareness within their overall body gestalt. Discussion : SIS and dream imagery can be incorporated into traditional Cognitive behavioral psychotherapy. This enrichment is based upon the interview translation of image based symbols into language for meaningful communication. This woman’s dormant OCD symptoms flared up in regard to the imminent stress of her son going to college. The first goal of treatment was to reestablish the therapeutic alliance. This was facilitated by supplementing traditional interviewing with an empathetic review of her imagery. Since she was not psychotic, she had insight into the fact that her sexual obsessive-compulsive symptoms were irrational. Yet she had not connected in her mind the temporal relationship between the reappearance of her OCD symptoms and her impending son’s loss. Of course the “Empty nest” aspect of her symptoms was immediately evident, to the clinician in the initial interview. Early in psychotherapy this was pointed out to her, but it took several sessions for this to really take hold in her mind. Multiple images previously presented were introduced into the court of reality testing as evidence. Of these, the tornado dream was particularly helpful. She experienced this imagery, when her understanding of her discomfort concerning her son’s graduation was growing. Thus, she realized that it was like a “Tornado” tearing him from her heart. Being intelligent, she spontaneously recognized that her absence in feeling horror at the mother’s loss - like other passengers in the dream -was “strange”. Her childhood history of trauma was consistent with developing a dissociative based mental disorder later life OCD (Fontenelle et al 2004). At this stage in the interview an explanation was given to her concerning the painful affect binding function of her obsessing and “Magical thinking”. This term in clinical circles refers to a common mental technique for controlling events through rituals. One of the functions is the formation of fear of having harmed others (Williams et al 2005). Her obsessive fears that she had harmed her son reflected this mechanism. During psychotherapy, she was reminded about spontaneously projecting an image onto SIS A4 of the “Tornado” leading to a mother’s loss of an infant. It was suggested to her that the subsequent response later at home “A silhouette of a man with raised fists” reflected her unexpressed emotional pain, sadness and repressed rage. It was pointed out to her that 110 Case & Dubey

losing a loved one triggers such feelings and that grieving facilitates relief. Concurrently, behavioral psychotherapy techniques were employed. For example, she was encouraged to tolerate the mental discomfort of delaying for longer periods her compulsive questioning of her husband and son. She was asked to chart her progress in a daily diary’. As in the previous psychotherapy years ago, it was very threatening for her to explore the meaning of the “Mutilated” breast symbol. She was able to recognize that termination of breast feeding had affected her more emotionally than she had originally realized. When your breasts were shrinking as lactation ended, maybe they felt like they were mutilated”. “Did it feel as disturbing as the way you felt in viewing A27?” etc. etc. However, the degree of threat in exploring this pathologic anatomical projective response seemed substantial. As indicated this suggested that the early life stressors previously formulated may have been strong determinant of this avoidance. Not wishing to open unprocessed painful childhood events, the significance of her failure to detect a nurturing maternal figure in 28B was not introduced into psychotherapy. Many times it is prudent to avoid overwhelming someone whose current life stressors are already giving rise to incapacitating symptoms which already are incapacitating. Acknowledgement : The authors wish to acknowledge their appreciation to the OCD suffering woman for giving permission to share her clinical history. References: Baer, L. (1994) Factor analysis of symptom subtypes of obsessive-compulsive disorder and their relation to personality and tic disorders. J clinical Psychiatry, 55:3, 18-23. Feygin,D.l., Swain,J.E., Leckman, J.F. (2004) The normalcy of neurosis: evolutionary origins of obsessive-compusive disorder and related behaviors. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:854-864Fontenelle LF, Mendlowicz MV, Marques C, Versiani M: Transcultural Aspects of Obsessive-compulsive disorder: a description of a Brazilian sample and a systematic review of international clinical studies. J Psychiatr Res, 38: 854-864. Fontenelle, L.F., Mendlowicz, M.V., Marques, C., Versiani, M. (2004): Transcultural Aspects of Obsessive-compulsive disorder: a description of a Brazilian sample and a systematic review of international clinical studies. J Psychiatr Res, 38: 403-411. Fontenelle, L.F., Domingues, A.M. and Souza, W.F. (2007) History of trauma and dissociative disorders among patients with obsessive-compulsive disorder and social anxiety disorder Psychiatr Quarterly, 78:241-250. Hasler, G., Pinto, A., Greenberg, B.D., Samuels, J., Syer, A.J., Pauls, D., Knowles, J.A., McCracken, J.T., Tini, J., Ridle, M.A., Rauch, S.L., Rasmussen, S.A., Willour, B.L., Gravos, M.A., Cullen, B., Biendenu, O.J., Shugart, Y.Y., Lind, K.Y., Hoehn-Faric, R., Wang, Y., Ronquillo, J., Nestat, G., Murphy, D.L. (2007) OCD collaborative genetics study: Familiaty of factor analysis-derived analysis YBOCS dimensions in OCD -affected sibling pairs from the OCD Collaborative Genetic Study. Biol Psychiatry, 61:617-625. The Mutilated Breast Syndrome 111

Heron, J., O’Connor, T.G., Evans, J., Golding, J., and Glover, V. (2004). “The course of anxiety and depression throughout pregnancy and postpartum in a community sample. J Affective Disorders. 80: 65-73. Hollander, E., Kim, S., Khanna, S., Pallanti, S. (2007) Obsessive-compulsive disorder and obsessive compulsive spectrum disorders: diagnostic and dimensional issues. CNS Spectr, 12:3, 5-13. Leckman, J.F., Grice, E.D., Boardman, J., Zhang, H., Vicale, A., Bondi, C., Alsobrook, J., Peterson, B.S., Cohen, D.J., Rathmusen, S.A., Goodman, W.K., McDougle, C.J., Pauls, G.L. (1997) Symptoms of obsessive-compulsive disorder Am J of Psychiatry, 154: 911-917. Mataix-Cols, D., Rauch, S.L., Mando, P.A., Jenike, M.A., Baer, L.(1999) Use of factor-analyzed symptoms dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. American J. Psychiatry,16: 1409- 1416. Mataix-Cols, D., Rosario-Camtos, M.C., Leckman, J.F. (2005) A multidimensional model of obsessive-compulsive disorder. Ameican J. Psychiatry, 162: 228-238. Matsumaga, H., Maebayashi, K., Hayashieda, K., Okino, K., Matsui, T., Iketani, T., Kiriike, N., Stein, D.J. (2008) Symptom structure in Japanese patients with obsessive-compulsive disorder Am J Psychiatry, 165: 251-253. Summerfeld, L.J., Richter, M.A., Anthony, M.M., Swinson, R.P. (1999) Symptom structure in obsessive-compulsive disorder: a confirmatory factor analytic study. Behav Res Therapy, 37: 297-311. Williams, M.T., Turkheimer, E., Schmidt, K.M., Oltmans, T.F. (2005) Ethnic identification biases responses to the Padua Inventory for obsessive-compulsive disorder. Assessment, 12:174-185. Williams, K.E., Koran, L.M. (1997) Obsessive -compulsive disorder in pregnancy, the puerperium, and the premenstruum. J. Clin Psychiatry, 58:330-334. 112 Case & Dubey Appeal Members of Somatic Inkblot Soceity are requested to kindly send their Annual dues before the 31st of January each year, to enable the Society to meet its expenses and smooth publication of the Journal.

on a specific content changed from content’s having a specific meaning to its belongingness to a cluster of related contents. The current research investigation is intended to determine whether there are significant differences in personality style, as measured by Sixteen Personality Factor Questionnaire Form-B (Hindi Adaptation), between people who give an adult female as a response to card VII and those who do not. One hundred (N=100) normal subjects, in the age range of 21-45 yrs of either sex, with minimum education up to 10 th class and who has given consent to take the test, were included in the study. General Health Questionnaire-12 items, Rorschach Ink Blot (Beck’s system) and Sixteen Personality Factor Questionnaire- Form B (Hindi Adaptation), were administered individually. Findings of the study showed that both groups differed significantly on four factors (Factor –A, H, N and Q3) out of sixteen bipolar personality factors. . It is apparent from the result that the subjects who perceived female content were warm hearted, participating, socially bold, spontaneous, shrewd, calculating, controlled, socially precise and following self image. Present research findings also reveals that inability to report female content on card VII seems to be related to social discomfort, dependency needs, passivity, introversion and social anxiety. The Rorschach has traditionally been considered to be a projective test consisting of a set of ten bilaterally inkblots. The overall goal of the technique is to assess the structure of personality with particular emphasis on how individuals construct their experience (cognitive restructuring) and the meanings assigned to their perceptual experiences: thematic imagery (Weiner, 1998, 2001, 2003). Despite attacks from both within and outside the field of psychology, the Rorschach test remains one of the most extensively used research techniques (Dubey,1982). With the introduction of the Comprehensive system (Exner,1993), the focus of Rorschach shifted from qualitative techniques to a standardized psychometric instrument. With this shift, the test lost its emphasis on projection and content became largely quantitative. There is tendency for particular cards to elicit specific responses, a phenomenon known as “Card Pull” (Weiner, 1998). Card pull, the tendency of the test stimuli to evoke or predispose certain cognitive and affective responses in the subject, is essential to the understanding and practice of projective testing.(Peterson and Schilling ,1983). Projection and card pull have long been recognized as complementary influences on the Rorschach response process. When subjects respond in terms of their personal associations to the inkblots, the responses they formulate are based largely on projection. When subjects respond in terms of the stimulus characteristics of the inkblots, the responses they articulate are based largely on card

pull. Virtually every Rorschach response combines the processes of perception and association in some proportion. Even popular and unelaborated responses that are clearly determined by stimulus characteristics of the blots involve some association. Thus, Card V looks like a bat to most of the people and is commonly seen as one, but very few people would endorse Card V as an exact replica or precise pictorial representation of a bat. Hence, some associational process is necessary to translate an impression of some bat like qualities in this inkblot into a formal response of “bat.” Relevant in this regard is the fact that subjects taking the Rorschach are not asked “What is this?” but rather “What might this be?” The pull in card VII has long been seen as associated with feminine percepts. The upper third is most often perceived as female figures, the popular response to card VII (area D1 or D9) being a human head or face, specifically identified as Indian, child or female (Exner, 1993).So, this card is known as “Mother Plate”. According to Klopfer and Davidson (1994) seeing these figures as children or animals, is often associated with social immaturity. They argued that individuals who give such responses can only express affect towards children and animals and may be unsuccessful with managing heterosexual relationship. Virtually everyone sees two girls or women. Deprecating descriptions of the figures “witches,” “gossips,” “girls were fighting,” “spinsters” indicate poor maternal relations. Perceiving the blot as thunderclouds instead of female figures suggests anxiety to some psychologists; seeing it as a walnut kernel may mean a vulgar fixation (S.P.A.R.C.2006). Klopfer figures as children or animals, is often associated with social immaturity. They argued that individuals who give such responses can only express affect towards children and animals and may be unsuccessful with managing heterosexual relationship. Virtually everyone sees two girls or women. Deprecating descriptions of the figures “witches,” “gossips,” “girls were fighting,” “spinsters” indicate poor maternal relations. Perceiving the blot as thunderclouds instead of female figures suggests anxiety to some psychologists; seeing it as a walnut kernel may mean a vulgar fixation (S.P.A.R.C.2006). Klopfer and Davidson (1994) also suggested that inability to visualize the percept of an adult female and a human movement response to card VII may indicate a disturbed mother child relationship. In other words, failure to see a female on card VII is worthy of interpretation from the psychoanalytical view point. Very few studies were conducted to evaluate the significance of such hypotheses. Thus, the present research investigation is an effort under such consideration. Aim of the study: The aim of the study was to determine whether there are differences in personality profiles, between people who give an adult female as a response to card VII and those who do not. Materials and Methods: The sample consisted of 100 normal subjects, who were chosen through purposive 114 Singh et al

sampling technique. Normal individuals (screened out by G.H.Q.-12 items) in the age range of 21-45 years, of either sex was included in the sample. However, the individuals with history suggesting mental retardation, substance abuse, significant mental, neurological or psychiatric illness and family history of mental illness were excluded from the sample. Education level of the subjects was 12th standard or above with predominant middle socioeconomic status from urban and sub urban areas. Tools: Tools used in the present study are: Socio Demographic Data Sheet especially designed for the study General Health Questionnaire :GHQ-12 (Shamsundar et al,1986) Rorschach Test 16 P. F Questionnaire – Form B (S.D. Kapoor 1978) Procedure: Initially, the prospective subjects were interviewed and subjects were chosen as per inclusion and exclusion criteria. There after subjects who could screened in as normal on G.H.Q.-12 were selected for the study. Information was crossed checked by reliable informants. Selected test were administered in to two sessions. In the first session, the Rorschach Test was administered and in the second session, Sixteen Personality Factors Questionnaire (Form-B) was administered following standard procedure. The Rorschach protocols were scored for female content on card VII. Records were divided into 2 groups: Group 1, “No –female”, consisting of subjects who gave no adult female response to card VII; and Group 2, “Female”, consisting of subjects who gave at least one adult female response. The female group consisted of 63 subjects,(39 males and 24 females), and the “No female” group 37 subjects (22 males and 15 females).The mean age of the Group 1 was 31.23±6.75 years and Group 2 was 29.82±8.13 years, with no significant difference. The two groups were further compared on 16 P.F. Questionnaire. Statistical Analysis: The obtained data have been treated by using standard scoring procedures of the individual tests. Statistical Analysis of raw data was done with the help of Mean, SD and’t’-ratio. Result and Discussion: It is evident from table that both groups (No Female content Group and Female content group) differ significantly on Factor-A: Reserved- Outgoing), (t = 39.6, P>.01) ,H: Shy- Venturesome (t = 23.15, P>.01), N: Forthright-Shrewd, (t = 14.06, P>.01) and Q3 : Undisciplined self conflict-controlled, (t = 15.88, P>.01) among various bipolar factors of sixteen personality factors questionnaire. It is apparent from the results that subjects who could give female content response were warm hearted, participating, socially bold, Female Figure on Card VII of Rorschach 115

spontaneous, shrewd, calculating, controlled, socially precise and following self image. On the other hand results also reflect that subjects who did not give female content response were more reserved, detached, critical, and shy and threat sensitive than those who perceived female content on Card VII. Interpretation of result also shows that subjects who did not give female response were forthright, genuine but socially clumsy, group dependent, accommodating, hesitating and agreeing introverting in nature. They react and accommodate to circumstances created by others and lack initiative. Generally they use their own thoughts and feelings as resources and get stimulation from within. They suppress their feelings and show compliance with others, when they feel that others will objects to their feelings. They are usually shy and nervous in social situation, wish to be liked by others and revealed fear of rejection. Klopfer and Davidson (1994) have documented that individuals having characteristics of shyness and nervous have fear of rejection. It might be the effect of some disturbances in the mother –child relationship during childhood. Table 1 Showing Means and Standard Deviation of 16 PF Questionnaire for the Group: No Female content on card VII and Female content on card VII Factors actors actors actors actors No F No F No F No F No Female content emale content emale content emale content emale content Female content emale content emale content emale content emale content t-ratio -ratio -ratio -ratio -ratio group group group group group group group group group group M SD SD SD SD SD M SD SD SD SD SD A - Reserved- Outgoing 2.45 0.2 6.41 0.4 39.6** B - Less intelligent-More intelligent 5.2 1.04 4.9 1.2 1.25 C - Affected by feeling-Emotionally stable 4.5 1.98 4.28 1.84 0.95 E - Humble-Assertive 4.05 0.65 4.20 0.4 0.93 F - Sober-Happy go lucky 3.99 1.08 4.12 1.05 0.59 G - Expedient-Conscientious 5.10 1.12 4.95 0.90 1.5 H - Shy-Venturesome 1.35 0.45 5.98 1.2 23.15** I - Tough minded-Tender minded 5.9 0.64 5.85 0.12 0.5 L - Trusting-Suspiciousness 5.2 1.95 5.35 0.87 0.75 M - Practical-Imaginative 5.35 1.02 5.7 1.05 1.75 N - Forthright-Shrewd 2.68 0.12 5.07 1.12 14.06** O - Placid-Apprehensive 5.98 .98 5.75 1.80 0.85 Q1 - Conservative-Experimenting 4.30 1.40 4.15 1.54 0.85 Q2 - Group dependent-Self sufficient 5.30 1.98 5.01 1.88 1.00 Q3 - Undisciplined self conflict-Controlled 3.00 0.20 5.70 0.98 15.88** Q4 - Relaxed-Tension 5.36 0.98 5.75 1.15 0.98 116 Singh et al

Table 2 Showing Means and Standard Deviation of 16 PF Questionnaire of Male and Female Subjects of Group-2(Female content on card VII group) Female Male ‘t’-ratio H-Shy-Venturesome 6.56 ± 0.23 4.41 ± 0.4 43.89** Q1-Conservative-Experimenting 5.45 ± 0.34 3.71 ± 0.36 45.12** Table-2 shows that female subjects differ significantly from male subjects on factor H: Shy-Venturesome (t = 43.89, P>.01) and Factor Q1: conservative-experimenting (t = 45.12, P>.01) on 16 P.F. Questionnaire. It become quite apparent from result that female subjects who perceived female content on card VII also differ in their personality profile from counter male sample. They were more restrained, diffident, timid, conservative, and tolerant of traditional difficulties than male. Conclusion : In spite of several limitations it is concluded that in view of the personality characteristics of the subjects who perceive the female figure on card VII of Rorschach Test found to be warmer hearted, participating, socially bold, spontaneous, shrewd, calculating, controlled, socially precise and following self image. Present research findings also reveals that inability to report female content on card VII seems to be related to social discomfort, dependency needs, passivity, introversion, and social anxiety. References : Beck, S.J.(1949).Rorschach Test,vol.1.Basic Process, New York. Dubey, B.L.(1982) A Pragmatic View of Rorschach Test. National Psychological Corporation, Agra. Exner, J.E.(1993).The Rorschach: A comprehensive system:vol.2.(2nd ed.).New York, Willey Klopfer,B.,and Davidson,H.H. (1994).The Rorschach Technique. An Introduction Manaual. O.S.Organization Speciali. Peterson CA and Schilling KM (1983). Card pull in projective testing. Journal of Personality Assessment. 47(3):265-75. S.P.A.R.C. (2006). The Rorschach Test http://www.deltabravo.net/custody/rorschach.php Shamsundar, C., Sriram,T.G., and Shanmugan (1986).Validity of a short version of GHQ. Indian J.Psychiatry, 28, 3,217-219. Weiner,I.B. (2001). Considerations in collecting Rorschach reference data. Journal of Personality Assessment. 77(1):122-127. Weiner,I.B.(1998). Principles of Rorschach Interpretation. Lawrence Erlbaum Associates. Mahwah, New Jersy. London. Weiner, I.B.(2003). Principles of Rorschach Interpretation. Lawrence Erlbaum Associates. Mahwah, NewJersy.London. Kapoor, S.D. (1978). Sixteen Personality Factor Questionnaire –Form B. Psycho Centre ,T-22, Green Park, New Delhi,India. Female Figure on Card VII of Rorschach 117

Diagnostic Efficiency of New Rorschach Depression Index (DEPI) Lissy George and Ranjeet Kumar The Rorschach Comprehensive System (Exner) included number of empirically derived constellation (such as DEPI) aimed at the identification of Depression. Depression Index was validated by various researchers. However a few independent studies on the diagnostic efficiency of the Depression Index have also suggested diverse result. The earlier studies have pointed out the need to analyze the sensitivity and specificity of the Depression Index. Taking these lacunae into account, the present study examined the diagnostic efficiency of the new version of Rorschach comprehensive system’s Depression Index. Patients with the diagnosis of recurrent depression (N-30) as per the ICD-10 criteria and 30 normal healthy controls from general population were assessed on Rorschach. Results indicate that patients with depression scored more on Depression Index with high specificity and low sensitivity. The Rorschach test assess broad personality characteristics and their behavioral proclivities (Blatt, 1990; Exner, 1988; Weiner, 1997) by evaluating cognitive processing via examination of the meaning the individual has assigned to their perceptual experiences (Exner et al., 1978; Weiner, 1997). The perceptual-cognitive processes that invoke subjects in formulating and articulating their responses provide clues to their characteristic ways of dealing with life experiences and their psychological states and traits. It also helps to understand how they process information and how they prefer to cope with problemsolving situations (Weiner, 1986). According to Garber and Kaminski (2002) the Rorschach conceptualizes different types of shortcomings in individual cognitive-perceptual processing. Specifically, the Comprehensive system evaluates markers of depressive symptomatology that manifest in specific ways of performing, and correspond with affective functioning, negative cognitions, and cognitive complexity or coping resources (Exner, 1993). In Comprehensive System Exner introduced DEPI, aimed at the identification of depression (Exner, 1991, 1993). The DEPI has two versions. The first version was introduced in 1982 (Exner and Weiner,1982). In 1986 Exner replaced the original DEPI due to the diagnostic imprecision. On the findings of further research he suggested that at least 15 variables must be present before it is categorized as depression or affective disturbance. These 15 variables were arranged within 7 criteria which constitute the revised DEPI (Exner, 1990b). According to Exner the new DEPI (Exner, 1991) is both sensitive and specific. DEPI correctly identified 75% of inpatient with depressive symptoms. However, 3% non-patients had 5 or more criteria on the DEPI (Exner, 1993). By using Exner’s data, Ganellen (1996b) calculated diagnostic efficiency (sensitivity .75 and specificity .81) of the revised DEPI on schizophrenic control group (n=320) alone and .92 when calculated on a mixed Lissy George, M Phil and Ranjeet Kumar, M Phil, Ph D., Asst. Prof. of Clinical Psychology, Gwalior Mansik Arogyashala,Gwalior M.P., E-mail: ran_psy@yahoomail.co.in, Cell: 09406586814 Key Words : Comprehensive Systems. Rorschach, DEPI, Specificity, Sensitivity, Depression

clinical and non-clinical control group (n=1,020).He concluded that the DEPI is useful for diagnosing depression. However, other independent studies have found that the original and revised versions of the DEPI lack sensitivity and are unrelated to diagnoses of depression (Archer and Krishnamurthy, 1997; Caine et al., 1995; Carlson et al., 1997; Carter and Dacey, 1996; Meyer, 1993; Sells, 1990,1991; Singer and Brabender,1993). In a recent review about the diagnostic efficiency of the Depression Index, Jorgensen et al. (2000) concluded that the index seemed to have relatively more success in identifying non psychotic and unipolar depressions than the psychotic and bipolar depression. Subsequent independent studies which deal with the Rorschach depression index were providing data about unsatisfactory diagnostic performance (Archer and Krishnamurthy, 1997; Ball et al 1991; Caine et al 1995; Singer and Brabender, 1993). Also there is no reported Indian studies about the diagnostic significance of the new Rorschach index. Te present study, therefore, aimed (1) to understand the diagnostic efficiency of the new Rorschach Depression Index in Indian context, (2) to find if DEPI is a specific measure of depression and (3) to find the profile of the depressive patients on Rorschach. Methodology : The study was conducted at Central Institute of Psychiatry, Ranchi. Cross-sectional design with purposive sampling method was used. the sample comprised of 60 subjects (30 depressive patients and 30 normal controls) between the age group of 18 to 55. The patient group constituted in and out patients both male and female diagnosed as first episode of severe depression and recurrent depression as per ICD-10 diagnostic criteria (World Health Organization, 1992). The non-psychiatric group constituted 30 healthy volunteers with age and education. Drug naive or on drug for not more than a week prior to Rorschach administration were the inclusion criteria. Presence of co-morbid substance abuse or any other psychiatric disorders, history of neurological illness or head injury, and illiteracy were taken as exclusion criteria for both the groups. Procedure : After the consent and rapport with subjects, the clinical and socio-demographic data was collected. A semi-structured socio-demographic data sheet was use for recording the data. T he Hamilton Depression Rating Scale was administered on depression group and the General Health Questionnaire was administered on the normal group. Persons who showed severe depression (SIGH-D) comprised the patient group and those who scored 2 or less on GHQ comprised the normal group. One of the authors (LG) administered Rorschach Inkblot Test. Protocols with less than 14 responses were discarded. The Rorschach administration and scoring was done following Exner’s System. A score of 5 on DEPI was considered to differentiate between depressive patients and normal healthy controls. A blind diagnosis was also done by a clinical psychologist Rorschach Depression Index 119

independently on twenty randomly selected Rorschach protocols from each group. Table 1 showed the reliability statistics estimated and interpreted as per the standard guidelines (Meyer, 1999; Cicchetti, 1994).In the present study the Rorschach Depression Index was used as the main tool. The Rorschach Depression Index (DEPI): Criteria I. (FV + VF + V > 0) or (FD > 2) Criteria II. (Color-Shading Blends> 0) or (S>2) Criteria III. (3r + (2)/R >.44 and Fr + rF =0) or (3r+ (2)/R<.33) Criteria IV. (Afr < .46) or (Blends < 4) Criteria V. (Sum Shading > FM + m) or (Sum C’>2) Criteria VI. (MOR > 2) or (2AB + Art + Ay >3) Criteria VII. (COP < 2) or (Isolate/R >.24) A DEPI value of 5 indicates likely hood of the presence of depression but not necessarily definitive, whereas values of 6 or 7 provide more certainty. Statistical Analysis: Statistical Package for Social Sciences (SPSS 10.0) was employed for analysis of data. Verification of the hypotheses was done by using student t and Chi square test. The diagnostic efficiency of the DEPI was calculated as described by Kessel and Zimmerman (1993).Sensitivity refers to the detection rate, which measures the proportion of those with depression, correctly identified by the DEPI Index. Specificity refers to the proportion of agreement between the Index and ICD-10 about not having depression in the present sample. Hit rate refers to the proportion of correct classification of those with and without depression in the given sample. Positive predictive validity refers to the probability that an individuals has depression given that DEPI are positive. Negative predictive validity refers to the probability that an individuals does not have depression given that DEPI are negative. Results : Student’s t’ test was computed to find the group differences in age, and the chi-square was computed to study the group differences in the various socio-demographic variables. There was no significant difference in the mean age of Depressive patients (34.03, 8.09,) and normal healthy Control (34.50, 9.65). No significant difference was found between the two groups on sex, marital status, education, occupation and socioeconomic status. The inter-rater for scoring of the Rorschach protocols were assessed in-terms of percent agreement between raters as well as kappa statistics (Table 1). Results revealed a high satisfactory inter-rater reliability of the Rorschach variables. 120 George & Kumar

Table 1 Inter-rater Agreement for the Rorschach Special Scores. Variables Observed agreement Kappa- value interpretation Location and space .94 .93 excellent Developmental quality .93 .89 excellent Determinants .89 .90 excellent Contents .94 .90 excellent Form quality .92 .93 excellent Special scores .82 .87 excellent Table 2 Difference between Groups on Depression Index- Total Scores Variable ariable ariable ariable ariable Depression group Depression group Depression group Depression group Depression group Control group Control group Control group Control group Control group t value (df t value (df t value (df t value (df t value (df-58) -58) -58) -58) -58) Significance Significance Significance Significance Significance mean& SD mean& SD mean& SD mean& SD mean& SD mean& SD mean& SD mean& SD mean& SD mean& SD DEPI total 4.30 ± 1.18 2.83 ±.59 6.090 .001*** *** Significance level.001 Table 3 Number of Individuals Fulfilling the DEPI Criteria in Depressive and Control Groups Variables ariables ariables ariables ariables Depression group Depression group Depression group Depression group Depression group Control group Control group Control group Control group Control group c2 (df=1) c2 (df=1) c2 (df=1) c2 (df=1) c2 (df=1) Significance Significance Significance Significance Significance (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) 5 or above 5 14 (46.67) 0 (0) 18.26 .000*** Below 5 16 (53.33) 30 (100) *** Significant at .001 level The depressive group scored significantly higher than the control group on the total score of Depression Index (Table 2). In depressive group 46.67% people were fulfilling the criteria but in the control group nobody fulfilled the criteria of DEPI. Chi-square value indicates significant difference (p <.001) between the groups (Table 3). When taking the DEPI = 5 the diagnostic efficiency of the DEPI was; the sensitivity, .47, specificity, 1.00, PPP 1.00, NPP.65, and hit rate .73 (Table 4). Rorschach Depression Index 121

Table 4 Shows the Diagnostic Efficiency Value of DEPI Variables ariables ariables ariables ariables Values alues alues alues alues Sensitivity .47 Specificity 1.00 Positive predictive power 1.00 Negative predictive power .65 Hit rate .73 When comparing the scores of the DEPI variables of the both groups (Table 5) there was significant difference between the groups on Criteria II (p <.05), Criteria III (p <.05), Criteria IV (p <.01) and Criteria V (p<.05). On these entire criterions depressive group scored more as compared to control group. However, Criteria I, Criteria V and Criteria VII shown no significant differences. Table 5 Comparison between Depressive Group and Control Group on DEPI Criteria Criteria Criteria Criteria Criteria Criteria Variables ariables ariables ariables ariables Depressive Depressive Depressive Depressive Depressive Control Control Control Control Control c2 (df=1) c2 (df=1) c2 (df=1) c2 (df=1) c2 (df=1) Sig. Sig. Sig. Sig. Sig. Group (%) Group (%) Group (%) Group (%) Group (%) Group (%) Group (%) Group (%) Group (%) Group (%) Criteria I FV+VF+V>0 OR (FD<2) 26.67 3.45 .063 Criteria II Col-Shd Blends>0 OR (S>2) 36.67 5.96 .015* Criteria III 3r+ (2)/R>.44 and Fr+rF =0 96.67 76.67 5.19 .023* OR 3r+(2)/R<.33 Criteria IV (Afr<.46)OR (Blends< 4) 96.67 63.33 10.41 .001*** Criteria V Sum Shading> FM+ m) OR 6.67 5.455 .020* (SumC’> 2) Criteria VI (MOR > 2)OR 1.17 .278 (2AB + Art + AY > 3) Criteria VII (Cop< 2) or 3.15 .079 (Bt+2×Cl+Ge+Ls+2× Na/R>.24 * Significance level < .05, *** Significance level < .01 122 George & Kumar

Table 6 Shows the Differences between the Depressives and Control Group on DEPI Variables Variables ariables ariables ariables ariables Depressive group Depressive group Depressive group Depressive group Depressive group Control group Control group Control group Control group Control group c2 c2 c2 c2 c2 Sig. Sig. Sig. Sig. Sig. (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (df =1) (df =1) (df =1) (df =1) (df =1) FV+VF+V> 0 16.67 .111 .739 FD> 2 3.750 .053 Colour-shading Blends >0 3.33 1.017 .313 S > 0 7.20 .007** 3r+(2)/R> .44 and Fr+ rF=0 6.67 13.33 .741 .389 3r+(2)/R < .33 63.33 56.67 .278 .589 Afr <.46 16.67 24.093 .000*** Blends <4 96.67 66.67 9.017 .003** Sum Shading>FM+m 3.33 3.33 .00 1.00 Sum C’>2 6.67 2.308 .129 MOR >2 16.67 5.45 .020* 2AB+Art+Ay>3 3.33 6.67 .351 .554 COP< 2 10.588 .001*** Isolate/R> .24 33.33 8.076 .004** * Significance level < .05, ** Significance level < .01, *** Significance level < .001 While considering the difference between the depressive group and control group on 15 DEPI variables (Table 6), there was significant deference between the groups on S> 0 Afr <.46, Blends <4, MOR > 2, COP < 2 and Isolate/R > .24. On these variables depressive group had significantly high scores than the control group. However other variables, namely FV + VF + V> 0, FD > 2, Clour-shading Blends > 0, 3r+ (2)/R> .44 and Fr + rF =0, 3r+ (2)/R < .33, Sum Shading > FM + m, Sum C’> 2 and 2AB + Art + Ay >3 had shown no significant differences between the groups. Discussion : The study was conducted to find out the effectiveness of the established interpretive cutoff scores of the test (DEPI = 5) in classifying subjects with or without Depression. Results revealed significant difference between the groups in fulfilling the DEPI criteria. Out off thirty subjects, 14 (47%) depressive patients fulfilled the criteria whereas none of the normal subjects fulfill the criteria. DEPI could perform very low in identifying the depression in the present study as compared to Exner’s psychiatric sample of inpatient depressives (n=315) where 75% had the DEPI value equal to or greater than 5 (Exner, 1995). The findings of the present study should be interpreted in the light of other factors also. Rorschach Depression Index 123

Mayer (1993) found a moderate impact of R (number or response) on the DEPI, where protocols with high-R (R = 29) were positive on the DEPI than low protocol (R = 17). Jorgensen et al (2000) reported that high Lambda is likely to reduce the probability of a positive DEPI. In the present study, the depressive group fulfilled both the conditions, which might have an influence on the low sensitivity. In a recent study, Chaudhury et al. (2006) indicated that the Indian population tends to give significantly low number of total Responses than the western population. The depressives subjects obtained significantly high score (p <.001) than the control group, when DEPI’s mean differences was taken into consideration. An ideal predictive test would provide high sensitivity, high specificity, and low false positive and false negative rates (Ilonen et al., 1999). The present findings about the diagnostic efficiency of the DEPI shows sensitivity .47, specificity 1.00, positive predictive power 1.00, negative predictive power .65 and hit rate .73. The test results indicate low sensitivity, very high specificity and positive predictive power, moderate negative predictive power and hit rate. So far as the sensitivity (.47) and specificity (1.00) is concerned, the findings of this study is consistent with the findings of Jansak (1996,1997) who found the DEPI to be a highly specific (.93), but not sensitive (.42) measure of depression. A few studies have also reported low sensitivity (Singer & Brabender, 1999; Mayer, 2000; Caine et al, 1995) and high specificity (Exner, 1995; Caine et al, 1995; Ilonen et al, 1999) of the Rorschach’s DEPI criteria. The positive predictive power of the present study was supported by the findings of other studies also (Exner, 1995; Jansak et al, 1997; Mayer, 2000). The DEPI did not classify any of the normal subject as depression. Though the diagnostic efficiency statistics of the DEPI was confusing, the high level of PPP, suggests that the DEPI provides clinically relevant information regarding the presence of mood disorder, thus supports the findings of Ganellen (1996b) and Ilonen et al (1999). In agreement with Exner (1995) and Ilonen et al. (1999) the study yielded a moderate hit rate of .73. The findings should be taken with caution as the DEPI misclassified a large percentage of depressive patients as nondepressive. Jansak (1996, 1997) has reported that out of the 7 constellation criteria of DEPI, criterion 2, criterion 6 and criterion 7 contributed to the diagnosis of depression. In the present study, criterion 2 contributed significantly however, criterion 6 and 7 did not turn to be significant in diagnosing depression. The depressive group scored significantly high on criteria 3, 4 and criteria 5. The six variables of DEPI, S > 0, Afr <.46, Blends < 4, MOR > 2, COP < 2, and Isolate/R > .24 contributed significantly to the diagnosis of depression. The results contradicted the findings of Jansak (1996,1997) wherein none of the 15 single variables contributed significantly to the classification. Conclusions : The findings suggest that patients with depression scored more on DEPI criteria and they also scored more on many of the DEPI variables. The findings should be taken with 124 George & Kumar

caution as the sensitivity scores were low and NPP and hit rate were moderate. Though there was low sensitivity of Depression Index, it was able to differentiate between depressive and normal subjects. References : Archer, R.P., & Krishnamurthy, R. (1997). MMPI-A and Rorschach indices related to depression and conduct disorder: An evaluation of the incremental validity hypothesis. Journal of Personality Assessment, 69, 517–533. Blatt, S.J. (1990). The Rorschach: A test of perception or an evaluation of representation. Journal of Personality, 55, 394-416. Caine, S.L., Frueh, B.C., & Kinder, B.N. (1995). Rorschach susceptibility to malingered depressive disorders in adult females. In J. N. Butcher & C. D. Spielberger (Eds.), Advances in personality assessment. Volume 10 (pp. 165–174). Hillsdale, NJ: Erlbaum. Carlson, C.F., Kula, M.L., & St. Laurent, C.M. (1997). Rorschach revised DEPI and CDI with inpatient major depressives and borderline personality disorder with major depression: Validity issues. Journal of Clinical Psychology, 53, 51–58. Carter, C.L., & Dacey, C.M. (1996). Validity of the Beck Depression Inventory, MMPI, and Rorschach in assessing adolescent depression. Journal of Adolescence, 19, 223–231. Chaudhury, S., Augustine, M., Saldanha, D., Srivastava, K., Kundeyawala, S.M., Pawar, A.A., Ryali, V.S.S.R. (2006). Norms of the Rorschach test for Indian subjects. MJAFI, 62, 153-160. Exner, J.E., Armbuster, G.L., & Vigilone, D. (1978). The temporal stability of some Rorschach features. Journal of Personality Assessment, 42, 474-482. Exner, J.E. (1988). Problems with brief Rorschach protocols. Journal of Personality Assessment, 52, 640–647. Exner, J.E. (1990a). Alumni newsletter. Asheville, North Carolina: Rorschach Workshops. Exner, J.E. (1990b). A Rorschach workbook for the Comprehensive System (3rd ed.). Asheville, North Carolina: Rorschach Workshops. Exner, J.E. (1991). The Rorschach: A Comprehensive System. Volume 2: Interpretation (2nd ed.). New York: John Wiley & Sons, Inc. Exner, J.E. (1993). The Rorschach: A Comprehensive System. Volume 1: Basic Foundations (3rd ed.). New York: John Wiley & Sons, Inc. Exner, J.E. (1995). A Rorschach workbook for the Comprehensive System. (4th ed.). Asheville, NC: Rorschach Workshops. Exner, J.E. (2003). The Rorschach: A Comprehensive System. Vol. 1: Basic foundations and principles of interpretation (4th ed.). Hoboken, NJ: Wiley. Exner, J.E., & Weiner, I.B. (1982). The Rorschach: A Comprehensive System. Volume 3: Assessment of children and adolescents (1st ed.). New York: Wiley. Fiske, D.W., & Baughman, E.E. (1953). Relationship between Rorschach scoring categories and the total number of responses. Journal of Abnormal and Social Psychology, 48, 25-32 Ganellen, R.J. (1996). Comparing the diagnostic efficiency of the MMPI, MCMI-II, and Rorschach: A review. Journal of Personality Assessment, 67, 219–243. Rorschach Depression Index 125

Ganellen, R.J. (2001). Weighing evidence for the Rorschach’s validity: A response to Wood et al. (1999). Journal of Personality Assessment, 77, 1-15. Garber, J. & Kaminski, K.M. (2002). Laboratory and performance-based measures of depression in children and adolescents. Journal of Clinical Child Psychology, 29(4), 509-525. Goldberg D. (1978). Manual of the General Health Questionnaire. Windsor: NFER-Nelson. Goldberge, D.P., Gater, R., Sartorius, N., Ustun, T.B., & Piccinelli, M. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191-197. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, neurosurgery and psychiatry, 23, 56-62. Ilonen, T., Taiminen T., Karlsson, H., Lauerma, H., Leinonen. K., Wallenius. A., Tuimala. P., & Salokangas, R. K. R. (1999). Diagnostic efficiency of the Rorschach schizophrenia and depression indices in identifying first-episode schizophrenia and severe depression. Psychiatry Research, 87, 183-192. Jansak, D.M. (1997). The Rorschach Comprehensive System Depression Index, depression heterogeneity, and the role of self-schema (Doctoral dissertation, California School of Professional Psychology, San Diego, 1996). Dissertation Abstracts International, 57, 6576B. Jorgensen, K., Andersen, T.J., & Dam, H. (2000). The diagnostic efficiency of the Rorschach depression index and the schizophrenia index: A review. Assessment, 7, 259-280. Kessel, J., & Zimmerman, M. (1993). Reporting errors in studies of the diagnostic performance of self-administered questionnaires: Extent of the problem, recommendations for standardized presentation of results, and implications for the peer review process. Psychological Assessment, 5, 395-399. Meyer, G.J. (1992). The Rorschach’s factor structure: A contemporary investigation and historical review. Journal of Personality Assessment, 59, 117-136. Meyer, G.J. (1993). The impact of response frequency on the Rorschach constellation indices and on their validity with diagnostic and MMPI-2 criteria. Journal of Personality Assessment, 60, 153–180. Meyer, G.J., & Archer, R.P. (2001). The hard science of Rorschach research: What do we know and where do we go? Psychological Assessment, 13(4), 486-502. Sells, J.E. (1991). A validity study of the DEPI index: The Rorschach Comprehensive System (Doctoral dissertation, University of Utah, 1990). Dissertation Abstracts International, 51, 5590B. Singer H. K., & Brabender, V. (1993). The use of the Rorschach to differentiate unipolar and bipolar disorders. Journal of Personality Assessment, 60, 333–345. Weiner, I.B. (1986). Conceptual and empirical perspectives on the Rorschach assessment of psychopathology. Journal of Personality Assessment, 50, 472-479. Weiner, I.B. (1997). Current status of the Rorschach Inkblot Method. Journal of Personality Assessment, 68, 5-19. Williams, J.B.W. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742-747. 126 George & Kumar

Wood, J.M., Lilienfeld, S.O., Garb, H.N., & Nezworski, M.T. (2000). The Rorschach test in clinical diagnosis: A critical review, with a backward look at Garfield (1947). Journal of Clinical Psychology, 56, 395-430. Wood, J.M., Nezworski, M.T. & Stejskal, W.J. (1997). The reliability of the Comprehensive System for the Rorschach: A comment on Meyer (1997). Psychological Assessment, 9, 490-494. World Health Organization. (1993). ICD-10, Chapter (F): Mental and behavioural disorders. Diagnostic criterion for research. Geneva WHO. Rorschach Depression Index 127 Announcement 35th National Annual Conference of Indian Association of Clinical Psychologists IACPCON - 2009 Scheduled to be held at Secunderabad January 16th – 18th, 2009 Conference Secretariate : Dept. of Clinical Psychology Dr. P. R. Institute for Mental Health A Unit of Sweekaar Academy of Rehabilitation Sciences, Upkaar Complex, Upkaar Junction, Secunderabad - 03, A.P. Ph. : 040-2784 3338, 9885356608, 9949145562, Fax : 040-2781 0731 Email : iacpcon2009@yahoo.com / sweekaar@gmail.com Website : www.sweekaarars.org

Personality Differences Between Treated and Non-Treated Cannabis (Charas) Dependence Cases Vandana Sharma, Awadhesh Upadhyay and M. G. Sharma The study was under taken to ascertain personality characteristics of treated and non-treated Cannabis (Charas) dependence using projective technique of personality assessment. Fifty treated and 50 non-treated Cannabis (Charas) dependence cases from Varanasi (India) formed the sample of the study. Three groups were matched on age (25 to 50 years with a mean age of 25.45 years). Seven cards of T.A.T. (Indian adaptation) 1, 3BM, 4, 6 BM, 7 BM, 13 MF and 16 were used to ascertain personality characteristics on the five selected dimensions viz: form, need, subjective state and feelings, press and interpersonal relations. Results indicated that the characteristics associated with treated cannabis dependence cases are happiness, superior cordial relations, language, organization, emotional tone, imagination, dominance, achievement, counteraction, affiliation and sex capacity where as the characteristics associated with non-treated cannabis dependence cases are cognizance, aggression, rejection, autonomy, passivity, harm avoidance, acquisition, anxiety, inferiority, guilt and dejection. Drug dependence refers to physiological and psychological dependency. According to the current classification, physiological dependency to drug is characterized by habituation and withdrawal symptoms. Behavioral scientists have reported that drug dependence could be differentiated from non treated/treated dependence on various personality dimensions. Sharma and Thakur (1989) for example, compared drug dependents and non dependents using Mithila Mental Health Status Inventory and found that drug dependents showed significantly higher scores on alienation, emotional instability and social non conformity. Amir (1994) has also found that drug abuse group scores significantly higher on alienation and discomfort. On MMPI, scores on Psychopathic Deviate and Depression Scale has been found consistently high in heroin addicts (Craig, 1979), alcoholics, criminals and shoplifters (Beck and McIntyre, 1977). The Psychopathic Deviate Scale reflects sociopathic personality traits: an inability to learn from experience, difficulties in forming interpersonal relationships, impulsivity, feelings of alienation and an inability to plan ahead. Depression Scale scores reflect feeling of hopelessness and low self-esteem, and preoccupation with suicide and death (Dahlstrom and Dahlstrom 1975). In a study conducted that process of social misperception among heroin dependents may lead to isolation and decreased self-esteem which in term may provide attempts for experimentation with heroin (Giannini et. al, 1985). Darke et. al. (1994) found that antisocial personality disorder was predicted by younger age, being male poorer social functioning and current criminality. Effect of group behavior on personality differences have also shown in a number of researches (e.g. Marsh et.al. 1988, Montoya et. al. 1994, Anglin, et. al. 1998 and Roszell, 1987, Blaszezynsky et. al. 1985, Moro et.al. 1981). The present study attempts to clarify how the treated cannabis (charas) dependents differ on Thematic Apperception Test as compared to the non treated cannabis (charas) dependence cases. Vandana Sharma, Ph.D., Psychologist, S.I. Mental & Physical Health Society, C-33/204 -1B, Chandua Chhittupur, Varanasi-221002, Awadhesh Upadhyay, Ph.D., Reader, Deptt. of Psychology, U. P. College, Varanasi-221002 and M. G. Sharma, Ph.D. Lecturer, Sri Agrasen Kanya P.G. College, Bulanala-221003, Varanasi (India) Key Words: TAT in Addicts, Charas Addiction

Method : The sample consisted of 50 treated and 50 non treated male cannabis (charas) dependent cases of Varanasi district in India. They were in the age range of 25 to 50 years with a median age of 25.46 years. Both groups were matched on socio-economic status. The treated group had left the drugs at least for six months and they attended the center for follow-up. They did not have any kind of addiction after leaving the drugs in any form. The non treated cannabis (charas) dependents consistent of persons with addiction for a period of minimum three years. Thematic Apperception Test was administered to both the groups individually. Results and Discussion : With a view to comparing mean scores of the treated and non treated cannabis (charas) dependents on form, need, press, subjective state and feelings, interpersonal relations and outcome variables were analyzed using ‘t’-test of significance. Results of such analysis are presented in Tabl.1- 4 respectively. A glance at table 1 reveals that the two groups differ significantly on language, organization, emotional tone and imagination. The treated group showed higher mean scores on language, organization, emotional tone and imagination categories. This means treated cannabis (charas) dependents have clear expression of language, rich vocabulary and grammatically correct sentences as compared to the non treated cannabis (charas) dependents. The treated group showed good organization (i.e. describing logically major and mirror details of the picture and perfect internal consistency), cheerful, complete Table 1 Comparison of Treated and Non-treated cannabis (charas) dependence cases on Form Variable of TAT Form orm orm orm orm Treated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) Non - treated cannabis Non - treated cannabis Non - treated cannabis Non - treated cannabis Non - treated cannabis ‘t’-value df P. dependence dependence dependence dependence dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence M SD M S.D. Language 21.50 2.89 18.79 2.43 5.07 .01 Organization 18.78 2.73 13.70 2.09 10.47 .01 Emotional- tone 5.01 2.91 1.29 2.99 6.31 .01 Imagination 20.27 2.85 17.21 2.61 5.60 satisfaction, happiness and having rich range of imagery as compared to the non treated cannabis (charas) dependents. Sharma et al (2004, 2005, 2007) have found that dependents were significantly lower on language, organization, emotional tone and imagination. Scores obtained by the two groups on need variable were analyzed using ‘t’-test of significance and results are shown in table 2. Treated and Non Treated Cannabis Dependence 129

Table 2 Comparison of Treated and Non-treated Cannabis (Charas) Dependence cases on Need Variable Needs Needs Needs Needs Needs Treated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) Non - treated cannabis Non - treated cannabis Non - treated cannabis Non - treated cannabis Non - treated cannabis ‘t’-value ‘t’-value ‘t’-value ‘t’-value ‘t’-value df df df df df. P. dependence dependence dependence dependence dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence M SD M SD Cognizance 1.26 1.09 2.94 0.93 5.38 .01 Aggression 1.08 1.03 2.99 0.97 9.69 .01 Dominance 2.10 1.03 1.09 1.00 5.05 .01 Rejection 0.79 0.93 1.93 0.69 2.68 .01 Autonomy 1.60 1.01 2.89 1.19 5.89 .01 Achievement 2.98 1.01 1.38 0.91 3.41 .01 Passivity 1.97 0.73 2.98 0.98 5.67 .01 Harm- avoidance 2.09 0.93 3.36 1.08 8.85 .01 Counteraction 2.02 1.09 1.30 1.07 3.02 .01 Affiliation 2.89 1.64 1.08 0.98 6.70 .01 Acquisition 1.07 1.01 2.16 1.98 3.47 .01 Sex 2.79 0.93 1.71 0.71 3.14 .01 It is clear from table 2 that treated and non treated cannabis (charas) dependents differ significantly on cognizance, aggression, dominance, rejection, autonomy, achievement, passivity, harm avoidance, counteraction, affiliation, acquisition and sex need. The treated addicts have significantly higher scores on dominance, achievement, counteraction, affiliation and sex and non- treated on remaining other needs i.e. cognizance, aggression, rejection, autonomy, passivity, harm avoidance and acquisition. In a study Craig and Olson (1988) indicated that after treatment drug dependents showed increased needs for achievement dominance, endurance and orderliness, The present study is quite contradictory to the findings of previous study of Craig and Olson( 1998). Gas et.al (1985) reported that drug addicts were not alert for new information. This study is also quite contradictory to the previous findings of Gas et. al. to some extent but aggressiveness, isolation, hostility and egoism were the main traits attributed to the drug addicts. Sharma (2005) has reported that dependents were higher on aggression, autonomy, cognizance, dominance, rejection, achievement, counteraction, affiliation and sex. Scores obtained on subjective state and feelings were analyzed with the help of ‘t’ test of significance on anxiety, inferiority guilt, dejection and affection variables and the results are shown in table 3. 130 Sharma et al

Table 3 Comparison of Treated and Non-treated Cannabis (Charas) Dependence cases on Subjective State and Feelings Variables ariables ariables ariables ariables Treated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) Non- treated Non- treated Non- treated Non- treated Non- treated cannabis cannabis cannabis cannabis cannabis ‘t’-value ‘t’-value ‘t’-value ‘t’-value ‘t’-value df df df df df P. dependence dependence dependence dependence dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence M SD M SD Anxiety 3.09 1.96 5.00 2.19 4.62 .01 Inferiority 2.71 1.76 5.06 2.10 6.07 .01 Guilt 2.93 1.71 5.12 1.96 5.98 .01 Dejection 2.39 1.79 5.09 2.15 6.85 .01 Affection 5.06 1.99 2.99 2.01 5.20 .01 Table 3 revealed that two groups viz :treated and non-treated cannabis (charas) dependents did differ significantly on five variables i.e. anxiety, inferiority, guilt, dejection and affection. Treated dependents have lower mean value on anxiety, inferiority, guilt and dejection and higher on affection variables. Roszell (1987), Cernovsky (1986) and Viney et.al. (1985) reported in their study that drug addicts have scored higher on anxiety, depression, anger and fear social interactions than the non-addicts. The findings however, reveal that the treated cannabis (charas) dependents have significantly higher scores on affections and lower on anxiety, inferiority, guilt and dejection. In a previous study, Sharma (2005) revealed that drug dependents have higher on anxiety, inferiority, guilt and dejection and lower on affection and it is quite contradictory to the present study. An attempt was also made to compare mean scores of treated and non-treated charas addicts on press, interpersonal relations and outcome variables, using ‘t’- test of significance. Results are show in table 4. Table 4 Comparison of Treated and Non-treated Cannabis (Charas) Dependence cases on Press, Interpersonal Relations and Out Come Variables ariables ariables ariables ariables Treated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) reated cannabis (charas) Non- treated cannabis Non- treated cannabis Non- treated cannabis Non- treated cannabis Non- treated cannabis ‘t’-value ‘t’-value ‘t’-value ‘t’-value ‘t’-value df df df df df P. dependence dependence dependence dependence dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence (charas)dependence M SD M SD Beneficial -Harmful 2.37 3.98 1.09 2.03 2.03 .05 Cordial-Conflictual 3.82 2.93 1.07 4.01 3.92 .01 Happy-sad 2.19 2.07 1.08 3.13 2.07 .05 Table 4 reveals that treated and non-treated cannabis (charas) dependents differ significantly on press, interpersonal relations and outcome variables. The treated group showed cordial relations, beneficial and happy out come. The mean value of three variables differs Treated and Non Treated Cannabis Dependence 131

significantly. Gas and Bajdok (1985), Anglin et.al (1998) and Sharma (2005) reported that drug dependents do not have better interpersonal relations in comparison to that of nonaddicts. Conclusion : The present research indicated that the treated cannabis (charas) dependents are good on language, organization, emotional tone, imagination, dominance, achievement, counteraction, affiliation, sex, happiness and good interpersonal relations. The characteristics associated with non-treated dependents are cognizance, aggression, rejection, autonomy, passivity, harm avoidance, acquisition, anxiety, inferiority, guilt and dejection. References : Anglin, M. Douglas, Ryan, Timothy, M. Booth, Mary, W. and Hsear, Yih-ing (1998). Ethinic differences in narcotic addiction: Characteristics of Chicago and Anglo methadone maintenance clients. International Journal of the addiction 32, 125-149 Amir, Taha (1994). Personality study of alcohol, heroin and poly drug abuser in an Arabian Gulf population. Psychological Reports, 72, 515-520. Beck, E.A. Mc Intyre, S. C. (1977). MMPI Patterns of shoplifters within a college population. Psychological Reports, 43, 1035 – 1040. Blaszezynskey, A. P., Buhrich, N. S. Mc Conaghy, N. (1985) pathological gamblers, heroin addicts and controls compared on the E.P.Q. ddiction’; Scale. British Journal of Addiction 80, 315 – 319. Cernovsky, Zdnek, C. (1986). Color preference and MMPI scores of alcohol and drug addicts. J. Clinical Psychology, 42, 668-668. Chowdhuri, Uma (1967). Manual of the Indian adaptation of the T.A.T. Published by Janaki Nath Basu for bookland Private Limted, 1 Sanker Ghose Lane, Calcutta-6. Craig, R. J. (1979). Personality characteristics of heroin addicts. A review of the empirical literature with critique- part II. International Journal of the Addiction, 14, 606 – 628. Craig, R.J. & Olson, Ronald, E. (1988). Changes in function ego states following treatment of drug abuse. Transactional Analysis Journal. 18(1) 6-26. Craig, R.J. & Olson, Ronald, E. (1990). MCMI comparison of cocaine abusers and heroin addicts. Journal of Clinical Psychology 6(2), 230- 237. Dahlstrom, W.G. Welsh, G.S. Dahlstrom, L.G. (1975). An MMPI Handbook, Volume I: Clinical Interpretations Minneapolis: Univ. of innesota Press. Darke, Shane, Swift. Wendy and Hall, Wayne (1994). Prevalence severity and correlates of psychological morbality among methadone maintenance clients. Addiction, 89(2), 211-217. Gas, Zbigniew B. & Bajdok, H. (1985). The role of information and the mage of drug addicts. Frzeglad Psychologically, 28, 483-495. Giannini, A.J. & Jone, T. (1985). Decreased perception of non verbal cues in heroin addicts. Journal of Psychology. 119(5), 455-459. 132 Sharma et al

Green, P.D. (1986). Associative response to double enterndre drug ords: A study of drug addicts and college students. Personality & social Psychology. Bulletin. 12(1), 31-39. Masrsh, D.T. Stile, S.A. Stoughton, Nancy. L. and Tout-L anden, Beth. (1988). Psychopathology of opiate addiction. Comparison data from the MMPI and MCMI. American Journal of the Drug and Alcohol Abuse. 14(1), 17-27. Moro, B.E. & Sardena, M. (1981). Methods of a diagnostic approach to heroin dependence: A preliminary study of 5 subjects. Psychiatria benerel. Della et. evaluate, 19(13), 247-263. Montoya, Ivan D. Hess, Judith M.Covi. Lino, Fudala, Paul J. et.al. (1994). A comparative study of psychopathology functions between cocaine and opiate dependent patients. American Journal of Addiction. 3(1), 36-42. Roszell, D.K. and Colasyn, D.A. (1987). Methadone dosage: Patients characteristics and clinical correlates. International Journal of the Addiction. 21(11), 1233-1246. Sharma, M.G. (2005). A comparative study of the personality characteristics of drug addicts and non addicts. Indian Psychological Review. 64(3), 137-142. Sharma, M.G. and Sharma, V. (2004). Personality characteristics and drug addiction. Perspectives in Psychological Researches, Vol. 27 & 28,121-123. Sharma, M.G. & Sharma. V, (2007). Mental health and death anxiety between pre treated and post treated narcotic addicts. The Asian Journal of Psychology & Education Vol. 40 (1-2). 36 – 38. Viney, Linda. L., Westbrook, M.T. and Preston Carol (1985). The addiction experience as a function of the addicts history. British Journal of Clinical Psychology, 24(2), 73-82. Walfish, Steven, Massey Renelle and Kron, Anton. (1990). MMPI profile of cocaine addicted individuals in residential treatment planning. Journal of Substance Abuse Treatment. 7(3), 151-154. Treated and Non Treated Cannabis Dependence 133 A case study is reported in every issue of the Journal. The readers are requested to send their comments to: Prof. Amool R. Singh, Ph.D., Editor in Chief, SIS Journal of Projective Psychology and Mental Health for publication in next issue of the journal. Also, please send your case study using projective test for publication in next issue of the journal.

Rorschach Profile of Neurotic Patients Shakti Mishra and M. P. Gupta The present study was conducted on 71 Neurotic cases taken from a private psychiatric hospital in Lucknow. The Rorschach test was administered following Beck’s method. The findings reveal that patient tend to give R between 11 to 20 and the location (D,Dd and S) depends on the number of responses. They give more F and low number of C,M and Shading responses. They rejected the cards but not frequently with constricted contents. Gender has no bearing on the Rorschach psychogram. Since its inception in 1921 (Rorschach,1921), the Rorschach test has got wide popularity and acceptability all over the world . A number of changes have been made over years in the administration and interpretation of Rorschach protocol by different groups of Clinical Psychologists in the Western countries. However, the most accepted techniques in use are by Klopfer (1954), Beck (1945, 1952, Exner,1986). Besides these, techniques devised by Pitrowiski (1965) have also received sufficient attention . The purpose of the Rorschach technique, like that of any other clinical instrument is to provide relatively standardized situation in which behaviour can be observed. As a projective technique, the Rorschach test has characteristic of providing ambigous stimulus situation enabling the subject to optimally reveal his inner personality. A number of efforts have been made to develop Rorschach norms on different groups of Psychiatric patients. Most of the work have been carried over in western countries . However, Indian Clinical Psychologists have also tried to develop norms on differnt normal and clinical population (Akhtar at a,1975, Dubey,1979, 1982, Kumar,1960,1963, Ramchandra,1994). Some of the Indian researchers Asthana (1971, 1977);Bagadia (1971); Dubey (1981, 1987) have carried over the work using Rorschach Test to find out the personality variables in Indian set up. Ramchandra (1994) has reported that Neurotic patients exhibited an average number of responses, quick reaction time, healthy emotional relationship with others . They had the ability to view their problems objectively and incisively.The quality of responses suggested a keen perception and dispostion to do things differently. The present study is an attempt to find out the Rorschach profile of Neurotic Patients of North East Regeon of Uttar Prades (India). Methodology : Sample : Rorscahch test was administered individually to each patient with the diagnoses of Neurosis by one of the author (Shakti Mishra). Beck’s method has been adopted for the interpretation of Rorscahch Protocols. The present study was conducted at Dr Thukral’s ‘Omnicare’ Center and ‘Sanjeevani Neurotic Psychiatric Center’, Lucknow, (U.P) during Shakti Mishra, Ph.D. Psychologist, Sahara Welfare Foundation, Behavioral Change Communication Center, Gorakhpur and M. P. Gupta, Ph.D. Ex Prof of Cl. Psy and Consultant Cl. Psychologist, Lucknow Key Words: Rorschach norms

the year 2002 – 2003. The sample consists of 71 patients, (42 Male and 29 Female) diagnosed as Neurotic Patients (including Anxiety (Group ‘A’), Depression (Group ‘B’), OCD (Group ‘C’), Dissociative disorder (Group ‘D’) on the criteria of DSM IV by the consultant psychiatrist. The Psycho–Social characteristics of the sample have been demonstrated in the tables 1 to 3. Table 1 shows that majority of the patients (70.42%) fall in the age group of 21 – 50 years; 23.94% of patients fall below 20 years and only 5.63% are above the age of 50 years . Table 1 Age Distribution of Male and Female Subjects Male Female Total Age N % N % N % 50+ 4.23 1.41 5.63 21 - 50 43.66 26.76 70.42 Below 20 11.27 12.68 23.94 Table 2 Educational Status Male Female Total Education N % N % N % Up to 8th 2.81 7.04 9.86 IX – XII 21.13 18.31 39.44 Graduation & above 35.21 15.49 50.70 Table 2 shows that more than 50% of the subjects were Graduation and above followed by 39.44% between IX to XII and only 10% below 9th standard. Table 3 Occupational Distribution Male Female Total Occupation N % N % N % Professionals (Teacher, 8.45 1.41 9.86 Doctor. & Engg.) Other Services Class 14.08 1.41 15.49 Business 16.90 16.90 Student 18.31 15.49 33.80 House Hold 1.41 22.54 23.96 Rorschach Profile of Neurotic Patients 135

table 3 shows that one third of the total patients belong to student group (33.80%) followed by household (25.35%), business (16.90), and other service class (15.49%). only (9.86%) of the sample have the professional occupation of teachers / doctors/ Engineers . Females dominate the household profession (22.54% vs 1.41%) and males dominate the business and services. Results and Discussion : The sample has been divided in to four categories on the basis of the number of responses to analyze the various findings of Rorschach indices . These are shown in table 4 . Table 4 Four Groups on the Basis of Total Number of Responses Group N % Range of Response A 18.31 Up to 10 B 66.20 11 to 20 C 12.68 21 to 30 D 2.81 30 & above Table 4 shows that the majority of the patients fall in the B Group (66.20%) followed by group A (18.31%), and group C (12.68 %) . More than 66% of the patients have given the total number of Responses between 11 – 20. Only 2.81% patients have given responses more than 30 . More or less similar patterns have been reported by western authors (Miali 1940, Fisher 1950). Low number of Responses may suggest low productivity, poor imaginative capacity and as a whole constricted protocol. Table 5 (A) Mean & S.D. of Location among Ddifferent Groups Response Group Response Group Response Group Response Group Response Group W D Dd/d Dd/d Dd/d Dd/d Dd/d S Mean + S.D Mean + S.D Mean + S.D Mean + S.D Mean + S.D. Mean + S.D Mean + S.D Mean + S.D Mean + S.D Mean + S.D. Mean + S.D Mean + S.D Mean + S.D Mean + S.D Mean + S.D. Mean + S.D Mean + S.D Mean + S.D Mean + S.D Mean + S.D. A (N=13) 0 – 10 4.15 2.03 4.69 1.88 0.33 0.36 0.077 2.28 B (N=47) 11 – 20 3.70 1.84 10.15 2.73 0.09 0.36 0.36 0.57 C (N=9) 21 – 30 3.22 1.39 20.11 3.55 0.66 1.00 0.66 0.71 D (N=2) 30+ 4.50 0.71 27.00 0.00 1.50 2.12 1.50 0.71 Table 5 (A) shows the mean and standard deviation of Location categories .As per expectation Mean of major location ‘D’ has been considerably higher than ‘W’, Dd & S . Nurotic Patients rarely see Space percept (S). Mean for Dd is quite low. The findings of location does not correspond with the western norms on Rorschach. 136 Mishra & Gupta

Table 5 (B) Values of Critical Ratio on Rorschach Location among Different Groups Location Response W D Dd/d S Group (A vs B) 0.763+ 6.77**** 2.25* 1.73+ (A vs C) 1.19+ 13.24**** 1.11+ 2.74** (A vs D) 0.24+ 16.30**** 2.26* 5.68**** (B vs C) 0.74+ 9.56**** 3.18*** 1.43+ (B vs D) 0.61+ 8.68**** 4.23**** 2.77*** (C vs D) 1.23+ 2.63* 0.91+ 1.51+ + Non –Significant * significant at .05 level ** Significant at .02 level *** Significant at .01 level **** Significant at .001 level Table 5 (B) shows the ‘t’ ratios among different groups of locations. No significant difference have been found among these groups on ‘W’. However the ‘t’ values differentiate the groups from .05 to .001 levels for the location of ‘D’ .As for as the location of ‘Dd’ . And ‘d’ is conceren, no significant difference has been found between two groups A vs C & C vs D , However , the difference between A vs B & A vs D is significant at .01 level . The difference is significant at .05 & .001 levels for the group B vs C and B vs D respectively .For the location of S no significant difference between group A vs B, A vs C, B vs C & C vs D., but B vs D , at .01 level and between A vs D at .001 level. As such no difference has not been found between the group C vs D for all the locations except for D, that too at .05 level only. Similar trend has been observed for Dd & S category. The over all findings are similar to the findings reported by Indian and Western studies. Table 6 Mean & S.D. of Location in Male and Female Subjects Sex W D Dd/d S Mean + S.D. Mean + S.D. Mean + S.D. Mean + S.D. M (n=42) 3.78 1.94 11.89 5.83 1.16 0.04 1.2 0.41 F(n=29) 3.68 1.60 10.38 6.29 2.00 1.15 1.66 1.032 Values ‘t’ 0.23+ 1.04+ 4.75****2.61** Table 6 shows the difference between male and female on different location categories. No difference has been observed between male and female on ‘W’ and ‘D’. However significant difference have been observed on Dd / d (‘t’ value 4.745). On Space response again, mean is higher for the females than that of the Males (Mean 1.66 & 1.20 respectively). Table 7 (A) shows the Mean and S.D. of different groups (A,B,C, and D) for Determinant categories. The mean values of the groups exhibit normal tend. Rorschach Profile of Neurotic Patients 137

Table 7 (A) The Details of Mean & S.D on Rorschach Determinants in Different Subgroups Determinants 0-10 A (N=13) 11-20 B (N=47) 21-30 C (N=9) 30+ (N=2) Mean + S.D. Mean + S.D. Mean + S.D. Mean + S.D. F 1.69 1.25 3.42 2.00 7.00 3.50 14.00 1.40 F+ 5.46 1.70 8.00 2.39 13.22 3.11 19.00 2.90 F- 0.00 0.00 0.23 0.47 0.00 0.00 0.00 0.00 FC 0.30 0.60 0.36 0.71 0.66 0.86 1.00 1.40 CF 0.24 0.59 0.94 1.03 1.33 1.32 0.50 0.71 FY 0.00 0.00 0.15 0.46 0.22 0.44 0.00 0.00 YF 0.07 0.27 0.11 0.38 0.00 0.00 0.50 0.71 FT 0.00 0.00 0.17 0.48 0.33 1.00 0.50 0.71 FV 0.00 0.00 0.00 0.00 0.11 0.33 0.00 0.00 M 0.00 0.00 0.27 0.57 0.33 0.50 0.50 0.71 M+ 1.08 1.50 1.02 1.29 1.88 1.76 2.50 0.71 M- 0.07 0.27 0.00 0.00 0.00 0.00 0.00 0.00 Table 7 (B) The Details of ‘t’ Value on Rorschach Determinants in Different Subgroups Determinants (A vs B) (A vs C) (A vs D) (B vs C) (B vs C) (C vs D) F 2.96*** 5.07**** 12.87**** 4.30**** 7.39**** 2.69* F+ 3.57**** 7.55**** 9.86**** 5.71**** 6.36**** 2.38* F- 1.76+ 0.00+ 0.00+ 1.46+ 0.69+ 0.00+ FC 0.24+ 1.15+ 1.32+ 1.51+ 1.22+ 0.45+ CF 2.25* 2.66** 0.59+ 1.01+ 0.59+ 0.84+ FY 1.15+ 1.84+ 0.00+ 0.44+ 0.45+ 0.68+ YF 0.27+ 0.82+ 1.69+ 0.84+ 1.42+ 2.71* FT 1.27+ 1.22+ 3.37*** 0.76+ 0.94+ 0.21+ FV 0.00+ 1.22+ 0.00+ 2.38* 0.00+ 0.45+ M 1.71+ 2.43** 3.37*** 0.28+ 0.53+ 0.40+ M+ 0.14+ 1.16+ 1.29+ 1.74+ 1.60+ 0.47+ M- 1.93+ 0.82+ 0.38+ 0.00+ 0.00+ 0.00+ Table 7 (B) shows ‘t’ ratios between different groups (that is A vs B; A vs C; A vs D; B vs C; B vs D; C vs D) on the determinants . The difference of the means among different group on F and 138 Mishra & Gupta

F+ have been found significant at .05 to .001. No difference have been found among these groups on F- and FC . None of the group perceived pure C. The CF differerred significantly at .05 level between A vs B and at 0.2 level between A vs C..No difference have veen observed on FY, YF except between C vs D at .05 level. Significant difference on FT was found at .01 level between the group A vs D, and on FV between the group B vs C at .05 level. The M differed significantly at 0.01 level between group A vs C and at 0.02 level between A vs D. Overall, the findings suggest that Neurotic groups perceive high F, low C and M. They rejected the cards but not frequently. The findings are comparable with the findings of Miale et al (1940); Munroe (1944) and Fisher, (1950) . Table 8 Mean and Standard Deviation for Rorschach Determinants in Male and Female Subjects Gender Male Female ‘t’ Value Determinants Mean + S.D. Mean + S.D. F 3.71 2.93 4.02 3.39 0.41+ F+ 8.02 3.47 8.79 4.12 0.85+ F- 0.12 0.40 0.21 0.40 0.92+ FC 0.41 0.73 0.45 0.74 0.25+ CF 0.79 1.00 0.90 1.11 0.44+ FY 0.12 0.40 0.10 0.31 0.18+ YF 0.07 0.26 0.21 0.49 1.55+ FT 0.14 0.47 0.21 0.60 0.50+ FV 0.02 0.15 0.00 0.00 0.70+ M 0.24 0.60 0.10 0.31 1.11+ M+ 1.43 1.55 0.86 1.09 1.70+ M- 0.02 0.15 0.00 0.00 0.83+ The Table 8 shows that gender difference does not have significant bearing on the Determents category of Rorschach Psychogram of the Neurotic Patients. Rorschach Profile of Neurotic Patients 139

Table 9 (A) Combined Mean and S.D. of Rorschach Contents among Different Groups Contents 0 – 10 11 – 20 21 - 30 A (N=13) B (N=47) C (N=9) D (N=2) Mean S.D Mean S.D Mean S.D Mean S.D H 0.92 0.86 0.96 1.30 1.44 0.88 1.5 0.71 Hd 0.38 0.87 0.85 1.16 1.55 0.73 3.00 1.41 (H) 0.46 0.66 0.19 0.45 0.78 0.66 0.00 0.00 A 5.38 1.61 7.49 2.71 10.78 3.07 16.00 5.66 Ad 0.31 0.48 1.13 1.38 2.22 1.78 6.50 2.12 An 0.31 0.63 1.55 1.99 2.33 1.58 0.05 0.71 (A) 0.00 0.00 0.25 1.05 0.00 0.00 0.5 0.71 Bt 0.77 0.83 1.19 1.50 0.00 0.00 1.67 2.08 Bl 0.08 0.28 0.13 0.47 0.11 0.33 0.00 0.00 Blot 0.00 0.00 0.02 0.15 0.11 0.33 0.00 0.00 Arch 0.08 0.28 0.13 0.49 0.00 0.00 0.00 0.00 Aircraft 0.00 0.00 0.06 0.25 0.00 0.00 0.50 0.71 Art 0.08 0.28 0.21 0.51 0.22 0.44 0.00 0.00 Fir 0.00 0.00 0.04 0.20 0.22 0.44 0.00 0.00 Skin 0.08 0.28 0.11 0.52 0.33 0.50 0.50 0.71 Sex 0.08 0.28 0.25 0.71 0.00 0.00 0.00 0.00 Obj 0.00 0.00 0.30 0.66 1.33 1.87 1.00 1.41 LS 0.15 0.38 0.19 0.54 0.44 0.73 0.5 0.71 Shadow 0.00 0.00 0.04 0.20 0.00 0.00 0.00 0.00 Mis 0.00 0.00 0.04 0.20 0.55 1.33 0.00 0.00 Map 0.00 0.00 0.06 0.32 0.06 0.03 0.00 0.00 Smoke 0.00 0.00 0.04 0.20 0.11 0.33 0.00 0.00 Cloth 0.46 1.66 0.06 0.44 0.33 0.50 0.50 0.71 Cloud 0.08 0.28 1.17 0.48 0.66 1.66 0.50 0.71 Nat 0.00 0.00 0.11 0.33 0.00 0.00 0.00 0.00 Rel 0.08 0.28 0.08 0.28 0.11 0.33 0.00 0.00 140 Mishra & Gupta

Table 9 (B) Values of Critical Ratio on Rorschach Contents among Different Comparison Groups Contents (A vs B) (A vs C) (A vs D) (B vs C) (B vs D) (C vs D) H 0.09+ 1.38+ 0.89+ 1.07+ 0.58+ 0.08+ Hd 1.34+ 3.31*** 3.74*** 1.75+ 2.57** 2.22* (H) 1.72+ 1.11+ 0.96+ 3.31*** 0.59+ 1.58+ A 2.66*** 5.39**** 6.36**** 3.27*** 4.22**** 1.93+ Ad 2.10* 3.71*** 10.93**** 2.68* 5.35**** 2.99** An 2.21* 4.20**** 0.53+ 1.10+ 1.06+ 1.94+ (A) 0.87+ 0.00+ 3.37*** 0.72+ 0.33+ 2.71* Bt 0.97+ 2.75** 1.20+ 2.37* 0.44+ 3.08** Bl 0.58+ 0.27+ 0.38+ 0.23+ 0.45+ 0.45+ Blot 0.49+ 1.20+ 0.00+ 1.35+ 0.79+ 0.45+ Arch 0.36+ 0.88+ 0.38+ 0.77+ 0.36+ 0.00+ Aircraft 0.93+ 0.00+ 3.37*** 0.77+ 2.29* 2.71* Art 0.93+ 0.96+ 0.38+ 0.05+ 0.59+ 0.68+ Fire 0.74+ 1.84+ 0.00+ 1.95+ 2.93*** 0.68+ Skin 0.20+ 1.55+ 1.69+ 1.21+ 1.04+ 0.41+ Sex 0.89+ 0.82+ 0.38+ 1.08+ 0.59+ 0.00+ Obj 1.63+ 2.55*** 3.37*** 3.02*** 2.43* 0.23+ LS 0.23+ 1.23+ 1.12+ 1.23+ 0.80+ 0.10+ Shadow 0.75+ 0.00+ 0.00+ 0.62+ 0.29+ 0.00+ Mis 0.75+ 1.52+ 0.00+ 2.58** 0.29+ 0.57+ Map 0.71+ 0.00+ 0.00+ 0.58+ 0.28+ 0.00+ Smoke 0.75+ 1.22+ 0.00+ 0.83+ 0.29+ 0.45+ Cloth 1.49+ 0.22+ 0.03+ 1.66+ 1.36+ 0.05+ Cloud 0.67+ 1.27+ 1.70+ 1.76+ 0.94+ 1.35+ Nat 1.19+ 0.00+ 0.00+ 0.99+ 0.47+ 0.00+ Rel 0.10+ 0.27+ 0.38+ 0.42+ 0.42+ 0.54+ Table 9 A & Table 9 B did nod suggest significant mean difference on H, Bl, Blot, Arch, Art, Skin, Sex, Ls , Shadow, Smoke, Map, Cloth, Cloud, Nat and Rel among the four groups. Rorschach Profile of Neurotic Patients 141

However, signifiant difference on Hd has been found between groups A vs C, A vs D, and B vs D at .01 level and C vs D at .o5 level. The Content of An is not significant for these groups except between the groups A vs B at .05 level & A vs C at .001 level. The content of (A) is significant between the groups A vs D at .01 level and C vs D. At .05 level. The content Bt is significant between groups A vs C & C vs D at .02 level & B vs C at .05 level. The content of Aircraft is significant between the groups A vs D at .01 level, B vs D and C vs D at .05 level. Significant difference has been found betbeen the group B vs D on Fire at .01 level, and on Obj at .01 level between the groups A vs C & A vs D. Table 10 Comparision of Rorschach Contents in Male and Female Subjects Contents Male Female ‘t’ Mean S.D. Mean S.D. H 1.16 1.19 0.86 1.12 2.74*** Hd 0.76 0.93 1.13 1.40 1.36+ (H) 0.28 0.55 0.30 0.54 0.10+ A 7.2 3.39 8.5 3.11 1.59+ Ad 1.14 1.28 1.45 2.13 0.75+ An 1.52 2.15 1.14 1.27 0.86+ (A) 0.04 0.2 0.03 0.00 0.47+ Bt 1.19 2.05 1.38 1.63 0.47+ Bl 0.16 0.49 0.14 0.44 0.25+ Blot 0.02 0.15 0.03 0.14 0.41+ Arch 0.09 0.48 0.14 0.35 0.40+ Aircraft 0.14 0.35 0.00 0.00 2.11* Art 0.24 0.53 0.25 0.07 1.59+ Fire 0.05 0.21 0.06 0.25 0.37+ Skin 0.26 0.63 0.17 0.34 0.68+ Sex 0.21 0.68 0.17 0.46 0.28+ Obj 0.45 1.11 0.36 0.60 0.67+ Ls 0.24 0.48 0.24 0.63 0.02+ Shadow 0.04 0.21 0.00 0.00 1.17+ Mis 0.07 0.26 0.14 0.74 0.53+ Map 0.05 0.31 0.18 0.18 2.15* Smoke 0.04 0.2 0.03 0.18 0.28+ Cloth 0.26 1.03 0.07 0.26 0.98+ Cloud 0.05 0.31 0.31 0.97 1.64+ Nat 0.11 0.47 0.00 0.00 1.19+ Rel 0.05 0.02 0.14 0.35 1.66+ 142 Mishra & Gupta

Table 10 suggests that male subjects perceived more H than females and the difference is significant at .001 level. Besides this, the contents of Aircraft and Map differentiate male and female at .05 level. Other contents could not differenciate male and Females. Table 11 (A) Combined Mean and S.D. on Rorschach Popular Response Among Different Groups 0 – 10 11 – 20 21 – 30 31+ A (N=13) B (N=47) C (N=9) D (N=2) Mean S.D. Mean S.D. Mean S.D. Mean S.D. 4.60 1.38 4.5 1.77 6.1 1.83 6.5 0.71 Table 11 (B) Comprision of Rorschach Popular Response in Male and Female Subjects Popular Mean S.D. Mean S.D. ‘t’ 4.76 1.63 4.62 1.45 0.37+ Table 11 A and Table 11 B suggest that the Popular responses (P) go up with the increase of total number of responses to some extent only as the Popular responses are independeant factor. The sex is not a significant variable in discriminating the groups on popular response. Conclusion : The present study concludes that patient in this regeon tend to give R between 11 to 20 and the location (D,Dd and S) depends on the number of responses. They give more F and low number of C,M and Shading responses. They rejected the cards but not frequently with constricted contents. Gender has no bearing on the Rorschach psychogram. Acknowledgement: Authors feel obliged to Dr. Thukral, former Neuropsychiatrist , Sanjay Gandhi P.G.I. Lucknow for collection of the data. References : Akhtar S. Prasad , D & Verma, S.K. (1975) A Rorscahch Study of obsessional Neurosis. Indian Journal of Clinical Psy. 2, 139 – 143 . Beck S.J. (1945) Rorscahch’s test; II A variety of Personality pictures . New York; Grune & Startton. Beck. S.J. (1952) . Rorscach test: III Advance in interpretation New York: Grune & Startton. Dubey, B.L.(1982) A Pragmatic View of Rorschach Test. National Psychological Corporation, Agra. Rorschach Profile of Neurotic Patients 143

Dubey. B.L., Pershad, D,Verma S.K. (1979), Rorscach response of different type of neurotics, J. Rajshthan Psycha. Society, 3:2, 29 – 32 Exner, J.E. (1986). The Rorschach. A comprehensive system volume I: Basis foundations, New York. A Wiley – Interscience Publication Fisher, S. (1950). The Pattern of personality rigidity and some of their determinants, Psychological monographs , 64, No. 307. Klofer, B., Ainsworth, M.D., Klofer, W.G. & Holt , R.R. (1954). Developments in the Rorscahch Technique , I Technique & Theory. New world Book Co. Kumar, P. (1960) The Rorschach test in Manic & Normal Groups . Indian Journal of Psychology, 35, 35 – 38 . Kumar, P. (1963). The Rorschach test in Schizophrenic and Normal Groups. Indian Journal of Psychology, 38, 121 – 124. Miale , F.R. & Harrower – Erickson. M.R., : (1940), Personality structure in the psychoneurosis . Rorschach Research exchange. 8: 46 – 70. Piotrowski, Z. A. (1965). The Rorschach Inkblot Method. In B.B. Wolman (ed.) Handbook of Clinical Psychology. New York; MC Graw – Hill. Munore, R.L. (1944) The inspection technique; A method of rapid evaluation of the Rorschach Protocol, Rorschach Research Exchange. 8:46 – 70. 144 Mishra & Gupta

Effect of School Environments on SIS-II Percepts Umed Singh and Naseeb Singh The present study was conducted to examine the impact of environment on the responses of Somatic Inkblots Images of two different school systems: the Government Schools and Gurukuls system in Haryana state (India). Two hundred male students (100 from government school and 100 from Gurukul System), matched with academic grade were randomly selected for the study. They were administered Somatic Inkblot Series (SIS-II) Booklet Form individually. The means, standard deviations and t-ratios were computed to compare the two groups. Obtained t-ratios have revealed significant mean differences in some of the SIS-II response patterns. Gurkul students obtained significantly high score on Movement responses, Atypical responses, Rejection of images, Pathological Anatomy scale, Depression scale, and Paranoia scale and low on Typical responses of Somatic Inkblots Images than the students of Government Schools. Despite attacks from both within and outside the field of psychology the inkblot tests have been the most extensively used and thoroughly researched techniques (Durand et al., 1988; Watkins et al., 1995). By now, there are three major standardized inkblot tests. The first amongst these is Rorschach Inkblot Test (Rorschach, 1921) which dominated the field of psycho-diagnosis unto 1950s. The second test was developed by Wayne Holtzman in 1956, popularly known as Holtzman Inkblot Technique (HIT) to overcome some of the limitations of Rorschach test by adding some psychometric properties. Because of the indices based interpretation of Rorschach and HIT, and the advent of psychometric approach of practicing psycho-diagnosticians, it shifted their preference form inkblot tests to the clinical questionnaire and other specialized scales for clinical assessment and evaluation. However, the questionnaire have their inherent weaknesses such as faking, social desirability, response sets, etc. (Cattell, 1957) which are sufficient to confound the findings of the test. The third test was developed by Wilfred Cassell (Cassell, 1964, 1965, 1977, 1980, 1994) and Cassell and Dubey (2003) to deal with above mentioned problems realized in traditional inkblot tests and questionnaire by introducing the Somatic Inkblot Technique popularly called Somatic Inkblot Series (SIS). Somatic Inkblot series is an extension and advancement of the traditional inkblot technique (Cassell, 1994). In 1959 Cassell germinated the idea of developing SIS while working with Fisher, an authority on body perception. The First series of the Test based on the concept of Body imagery was developed in 1960 to understand the manifestation of psychosomatic problems and to hear the inner cry of suffering individuals. The test has three theoretical postulates: ie Somatic Imagery, Body Symbolism, and Inner Cry. Somatic Imagery proposes that every individual has a unique and highly personalized system of attitudes both conscious and unconscious that is projected onto the body as a spatial entity. Body symbolism contends that an individual integrates mental and physical phenomena, and is based on old philosophical principle of mind-body relationship. The Inner Cry propagate that expressed behavior is the physical translation of pent up emotions in mental reservoir. Presently Somatic Inkblot Series provide images Umed Singh, Ph.D. and Naseeb Singh, M.Phil.(Psy), Dept. of Psychology, K.U. Kurukshera-136119 Key Words: School Environment, Gurukuls, Govt. Schools, SIS-II.

in five forms: Cards (SIS-I 20 cards), Booklet Form (SIS-II 62 images),Video tapes (SIS- I and SIS-II Video/CD/DVD) and Living Images. Review of literature on SIS reveals that SIS-II booklet form has attracted more researchers followed by the card form. It has only eleven scoring categories such as Total Number of Responses (R), Human Responses (H), Animal Responses (A), Anatomical Responses (At), Sex Responses (Sex), Movement Responses (M), Most Typical (MT), Typical (T), Atypical (AT), Rejection (Rej), and Pathological Scales i.e. Pathological Anatomy (PAS), Depression (D), Hostility and Aggression (HAS), and Paranoia (P). SIS technique emphases more on the content analysis and the psychoanalytic interpretation of the responses. The SIS test has been used as a diagnostic tool and therapeutic aid in varieties of clinical conditions such as psychoses and neuroses (Rathee et al., 1995, 2002); schizophrenia and depression (Prasad & Verma, 1995), murderers (Singh et al., 2000), ADHD (Jain et al. 2005), Coronary Heart Disease (Dubey et al., 1994), addiction (Mukhopadhyaya et al, 1996), obesity (Cinzia & Roberto, 1998), mania (Kumar et al., 2006), militancy (Saldhana, 2002), suicide (Cassell, 2006), violence (Cassell & Dubey, 2006), PTSD (Cassell, 2006), and problems of police personnel (Dubey & Dubey, 2005). Like other inkblot techniques, the stimuli presented by the inkblots are organized by the viewer’s specific needs, motives, conflicts, and perceptual sets. The person organize these perceptions as well as associate them with their past experiences and impressions. Thus, they perceive a response based on their personal internal images, ideas, and relationships projected by such images. The percepts reported by the subjects are deeply related to the past experiences and impressions stored into the unconscious. The past experiences, impressions, perceptions, and organizational processes are significantly influenced by varieties of factors such as socialization, family environment, peer groups, school environment, and other social institutions. The present study intends to study the effect of different school environments on the SIS-II responses of school students of Haryana. There are three school systems in Haryana: (1) Gurukuls; (2) Govt. Schools, and (3) Public Schools, which represent three types of school environment. Gurukuls represent the ancient Vedic system of education in which students remain in intimate relationship/interaction with their gurus/teacher in an enclosed area away from their homes. Students have to manage their own for everything i.e. cooking, personal maintenance, health, cleanliness and so on. They are taught about cultural heritage, traditions, values, customs, rituals, and highly controlled and disciplined ways of life in addition to the general academic education. Usually, parents with strong Vedic religious commitment send their sons/daughters to Gurukuls. Coeducation is not practiced in Gurukuls. Psychologically, the educational environment of Gurukuls can be designated as suppressive or non-stimulating. Government schools in Haryana represent the neutral school environment lacking the intimate relationship 146 Singh & Singh

between students and teachers. The government schools particularly located in rural areas cater the educational needs of lower and lower-middle income group students of the area. On the other hand, school environment of public schools is considered to be stimulating in the sense the students are exposed to variety of extracurricular activities in addition to the academic activities. The present study is an attempt to compare the students of Gurukuls and Government Schools for their responses on SIS-II test. Method: Sample: Two hundred male students (100 each from Government High Schools and Gurukuls, Jind and Kurukshetra Districts of Haryana) randomly selected, in the age range of14 to 16 years, participated in the study. These two types of schools represent two different school environments. The sample restricted to rural areas only. Measures: z Background information about the participants was obtained through a personal data-sheet designed for the present study to ascertain the rural domicile and similarity of socio-cultural background of the participants. z SIS-II (Booklet Form) consisting of 62 images was administered individually after establishing proper rapport. SIS-II protocols were scored for 14 categories according to scoring system developed by Cassell and Dube (2003). Results and Discussion: Frequency distributions of all the 14 variables used in the study were shown separately for both the groups (Government Schools and Gurukuls). Descriptive statistics i.e. Mean, Standard Deviation, Skewness, and Kurtosis were computed to ascertain the normalcy of data; and t-ratios were computed to compare the two groups in terms of significance of mean differences, which are reported in Table1. Perusal of Table 1 reveals that there are significant differences in students of Government schools and Gurukuls with regard to some of the SIS-II percepts. It can be noted that Gurukul students have scored significantly high on six of SIS-II indices viz Movement, Atypical, Rejection, Pathological Anatomy, Depression, and Paranoia; and low on Typical. It posits that Gurukul students tend to be more psychologically disturbed than the students of Government school. It depicts that Gurukul students project high level of implicit dynamic energy, perseverative tendency, thought blockade or suppressive hypochondriatic sensitivity, depressive affect and hyper-vigilance in their SIS-II percepts. The significant high score of the students of Government school on Typical responses hereby posits that they tend to perceive SIS-II images in terms of commonly seen percepts. Movement Responses : Movement responses are significantly higher in Gurukul students as compared to those Effect of School Environments 147

Table 1 Comparison of Mean Scores of Government School and Gurukul Students S. Variables Govt. School Gurukul Student t-values Level of No Student Mean/ SD Mean/ SD significance 1. Total Responses (R) 59.73 58.72 1.63 NS 1.44 6.12 2. Human (H) 12.91 13.76 -1.46 NS 4.22 4.00 3. Animal (A) 5.63 5.84 3.99 3.20‘ -.41 NS 4. Anatomy (At) 18.48 17.14 7.65 6.76 1.31 NS 5. Sex (sex) 1.73 1.50 1.99 1.24 .94 NS 6. Movement (M) 1.42 1.95 2.01 1.54 -2.12 Sig 7. Most typical (MT) 11.15 11.56 2.14 2.16 -1.28 NS 8. Typical (T) 22.99 12.99 4.85 3.68 16.39 Sig 9. Atypical (AT) 25.67 34.33 6.15 5.59 -10.43 Sig 10. Rejection (Rej) 2.19 2.71 1.44 1.62 -2.33 Sig 11. Pathological anatomy (PAS) .53 .86 . 1.03 -2.62 Sig 12. Depression (D) .17 .43 .98 -2.50 Sig 13. Hostility and Aggression (HAS) .92 1.24 2.12 .83 -1.52 NS 14. Paranoia (P) .01 .13 .10 .42 -2.4 Sig of Government school students. Rorschach (1942) contended M responses as indicative of internalization and an individual’s ability to handle more deliberate and sophisticated experiences in emotionally controlled way. Beck (1944) has taken M responses indicative of awareness towards the external world and reflecting some unexpressed conflicts and emotions in the realistic world. Werner (1948) has interpreted M responses in terms of sensory tonic hypothesis that higher M responses depict the motor delays in expressions of affect. Holtzman et al. (1961) have taken M responses as representing the implicit potential for dynamic energy. Hence, high M score of Gurukul students are well understandable in the light of above mentioned assertions and the suppressive nature of Gurukul environment in which students are made to lead highly imposing, controlled, and restricted life. Most of the dynamic and cognitive energy of students remain unexpressed. 148 Singh & Singh

Atypical Responses: The significantly higher atypical responses of Gurukul students as compared to their counterpart Government School students are again well understandable in the light of highly controlled and restricting environment of Gurukuls. The students after admission in Gurukuls, are not allowed to interact with rest of the world till the completion of their studies. Consequently, they remain deficient in the development of normative and social confirmatory behavior, perceptions, and capacities. They tend to suffer from cognitive lag. Therefore, they tend to perceive the SIS images more in terms of atypical percepts which are of poor quality and vague either in structure or verbalization. Rejection of Images: The Gurukul students have rejected significantly higher number of SIS-II images than the students of Government Schools. Rejection of Images is considered indicative of an inhibition or blockade of thoughts (Bohm, 1958, Cassell and Dubey, 2003). Though the rejection in both the groups is very low, however, difference has been found to be statistically significant. It is obvious in the light of the environment prevailing in the Gurukuls where the students live in highly restricted and controlled environment. Pathological Anatomy: Gurukul students have scored significantly high on Pathological Anatomy Scale as compared to the students of Government schools. It can be interpreted in terms of hypochondriac sensitivity (Cassell and Dubey, 2003). It further depicts the negative impact of highly restricted, impelling, and suppressing environment of the Gurkuls. In Gurukuls, there is overemphasis on physical health and observance of “Brahamacharya”. The teachings include such examples which reflect consequentially bodily dysfunctions and fears of health if brahmacharya and physical exercises are not undertaken. It may result into the development of health obsessions, which might have cultivated more pathological anatomy percepts in Gurukul students. Depression : The significantly high scores on Depression Scale by Gurukul students again are well understandable in terms of highly controlled and restrictive environment of Gurukuls. It certainly leads to conditioned suppression and learned helplessness which provide conceptual basis for the perception of SIS images in terms of depressive percepts in contents. Paranoia : Statistically significant higher scores by Gurkul students on this scale are indicative of paranoid ideation. It might be because of highly disciplined and restricted environment of Gurukuls, where the students are vulnerable to develop heightened awareness of threats, paranoid ideation and exaggerated sense of self-consciousness. Effect of School Environments 149

Typical Responses : Students of Government school have scored significantly high on this scale than the Gurukul students. It can be attributed to the fact that Govt. School students consistently interact with realistic world (i.e. family, neighbors, peers, school and other social agencies). As a result, they tend to develop the normative and confirmatory perceptions and behavior patterns. On the other hand, in Gurukuls, because of their restricted environment the students remain deprived of normative and confirmatory experiences rather they are impelled to develop idealistic cognitions and behaviors. Conclusion: The results of the present study demonstrate the power of SIS-II to index the differential effects of school environments on the percepts of SIS-II images. The finding, though reflects significant differences in school environment on SIS-II response patterns, yet can not be generalized. For this, investigations on large sample including students of Public school environment should be carried out for generalization of the findings. References: Beck, S.J. (1944) Rorschach Test, Vol. I Basic Process, New York: Greene & Stratton. Bohm, E. (1958) A Text Book on Rorschach Diagnosis (Tr. By A. Beck & S.J. Beck), New York: Greene & Stratton. Cassell, W.A. (1964) A Projective Index of Body Interior Awareness. Psychosomatic Medicine, 26: 172-177. Cassell, W.A. (1965) Body Perception and Symptom Localization. Psychosomatic Medicine, 27: 171-176. Cassell, W.A. (1977). Desensitization Therapy for Body Image Anxiety. Canadian Psychiatric Association Journal. 22: 239-242. Cassell, W.A. (1980) Body Symbolism and Somatic Inkblot Series. Anchorage, Alaska. Aurora Publishing. Cassell, W.A. (1980) SIS –II Booklet Form. SIS Center, Anchorage, Alaska(USA). Cassell, W.A. (1984) Somatic Inkblot Series Video. SIS Centre, Amehorago, Alaska (USA). Cassell, W.A. (1994 ) The Somatic Inkblot Series: Continuing Rorschach’s Conceptualization, SIS. Journal of Projective Psychology & Mental Health, 3: 3-32. Cassell, W.A. (2005) Assessing Suicidal/Homicidal Impulses with the SIS. SIS Journal of Projective Psychology and Mental Health, 12(2): 99-106. Cassell, W.A. (2006) SIS Cognitive Psychotherapy for Spouse Induced PTSD. SIS Journal of Projective Psychology & Mental Health, 13(1), 25-36. Cassell, W.A. and Dubey, B.L. (2003) Interpreting Inner World Through Somatic Imagery: Manual of Somatic Inkblot Series. SIS, Centre, Anchorage: Alaska (USA). Cassell, W.A. and Dubey, B.L. (2006) Tracing the roots of violence by associating Dream and SIS Images: A vicarious visit to an Adolescent’s Birthday party. SIS Journal of Projective Psychology & Mental Health, 13(2), 87-106. Cattell, R.B. (1957) Personality and Motivation: Structure and Measurement. Chicago: World Book Co. Cinzia, S. and Robesto, F. (1998) The SIS-I and Body Image Evaluation in subjects suffering from serious obesity. SIS Journal of Projective Psychology & Mental Health, 5: 105-113. 150 Singh & Singh

Dubey, S.B. and Dubey, B.L. (2005) Effect of Psychological Intervention Through SIS-I Images on Police Personnel. SIS Journal of Projective Psychology & Mental Health, 12(2), 153-158. Dubey, B.L., Mishra, M., Dwivedi, C.B., and Mishra, Nalini. (1994) Diagnostic and Therapeutic Utility of Somatic Inkblot Series-II and Rorschach. SIS Journal of Projective Psychology & Mental Health, 1: 19-26. Durand, V.M., Blanchard, E.B., Mindell, J.A. (1988) Training in Projective Testing: Survey of Clerical Training Directors. Professional Psychology: Research and Practice, 19, 236-238. Holtzman, W.H. (1956) Inkblot Perception and Personality. University of Texas Press, Texas. Holtzman, W.H., Thorpe, J.S., Swartz, J.D. and Herson, E.W. (1961) Inkblot Perception and Personality: Holtzman Inkblot Technique. Austin; University of Texas Press. Jain, R., Singh, B., Mohanty, S.R., and Kumar, R. (2005) SIS-I and Rorschach Diagnostic Indicators of Attention Deficit and Hyperactivity Disorder. SIS Journal of Projective Psychology & Mental Health, 12(2): 141-152 Kumar, D., Dubey, B.L. and Kumar, R. (2006) Gender Differences in SIS-I Profile of Manic Patients. SIS Journal of Projective Psychology & Mental Health, 13, 61-64. Mukhopadhyay, A., Banerjee, S., and Mitra, G. (1996) A Comprehensive Profile of Personality Characteristics of Male Drug Addicts. SIS Journal of Projective Psychology & Mental Health, 3, 33-41. Prashad, D., and Verma, S.K. (1995) Diagnostic Significance of Content Analysis of SIS-II. SIS Journal of Projective Psychology & Mental Health, 20, 141-149. Rathee, S.P., Pande, V., and Singh, A. (1995) Diagnostic Efficacy of Somatic Inkblot Series-II Among Psychiatric Patients of Armed Forces. SIS Journal of Projective Psychology Mental Health, 2, 61-66. Rathere, S.P., Pardal, P.K., and John, T.R. (2002) Diagnostic value of SIS-II Among Sub-groups of Psychotic and Neurotic Patients of Armed Forces. SIS Journal of projective Psychology and Mental Health, 9, 23-32. Rorschach, H. (1921) Psycho diagnostic. Ernst Bircher, Nern. Rorschach, H. (1942). Psycho diagnostic. New York: Greene & Stratton. Saldhana, D. (2002) Profile of Militants: An attempt to study the minds of militants. SIS Journal of Projective Psychology & Mental Health, 9, 23-32. Singh, A.R., Dubey, B.L., Sahu, L.M., and Banerjee, K.R. (2000) SIS-II Profile of Murderers. SIS Journal of Projective Psychology & Mental Health. Verma, S.K., Prashad, D., and Nehra, R. (1994) Cross-validation of SIS-II in Psychiatric Population. SIS Journal of Projective Psychology & Mental Health, 1, 15-18. Verma, S.K., Prashad, D., and Kaur, R. (1996) Interdependence of SIS variables with Personality Traits in Psychiatric Cases. SIS Journal of Projective Psychology & Mental Health, 3, 51-58. Watkins, C.E., Campbell, V.L., Nieberding, R., and Hallmark, R. (1995) Contemporary practice of psychological assessment by clinical psychologists. Professional Psychology: Research and Practice, 26, 54-60. Werner, H. (1948) Comparative Psychology of Mental Development. Chicago, Follett. Effect of School Environments 151

Psychological Defenses used by the Substance Dependents Nawab A. Khan, Masroor Jahan, Amool R. Singh and K.S. Sengar The self is the integrating core of personality and any threat to self is a threat to individual’s existence. Consequently, various defense mechanisms are gradually learned for protecting the self. The present study was conducted to find out the psychological defenses used by the substance dependents to defend their self. For this purpose, 30 substance dependents and 30 normal controls were selected through purposive sampling technique and Defense Mechanism Inventory was administered individually. Student’s t-test was used to find the differences in two groups. Results showed significant difference in psychological defenses used by the substance dependents and normal control group. Most notably used by Freud in his psychoanalytic theory, a defense mechanism is a tactic developed by the ego to protect against anxiety. Defense mechanisms are thought to safeguard the mind against feelings and thoughts that are too difficult for the conscious mind to cope with. Personality defenses (coping techniques, defense mechanisms) are important because they strongly influence the ease with which people are able to form and maintain healthy relationships. Reacting to frustrating, difficult and painful situations and experiences, they function as a computer firewall, helping to defend against hurting and abusive relationships and promote healthy and nurturing relationships. Defenses are important, an immune system unto themselves. At time we use them knowingly, though in many cases these defenses occur unconsciously and work to distort reality. While many defense mechanisms can be unhealthy, they can also be adaptive and allow us to cope and function normally. The problem arise when defense mechanisms are overused in order to avoid dealing with problems realistically. Individuals go through a reaction process when they are personally confronted with major organizational change (Jacobs, 1995; Kyle, 1993). According to Scott and Jaffe (1988) this process consists of four phases: initial denial, resistance, gradual exploration, and eventual commitment. The differences between individuals are in the overall degree of defense orientation as well. Some defense mechanisms are more primitive, some are In- Between Defenses others are Mature Defenses. (Grohol, 2007). The most primitive (or developmentally early) defense strategies are often predicated on a mistaken or inaccurate representation of social reality - which is the major reason why we call them ‘primitive’. Though they may work as a means of avoiding short term pain, they also generally do not usually result in constructive outcomes and aren’t much of help to someone looking for ways to solve problems. Primitive defenses include dissociation, projection, reaction formation, acting out and denial. ‘In-Between’ defenses also distort social reality, but far less than the primitive defenses (or in a less destructive manner). They are not necessarily constructive in nature, but using them probably won’t make problems worse. ‘In-Between’ defenses include repression, displacement, intellectualization and rationalization. Nawab A Khan, M. Phil, Research Assistant, CIP, Ranchi; Masroor Jahan, Ph.D. Associate Professor; Amool R. Singh, Ph.D.; Prof & Head ; K. S. Sengar, Ph.D., Assistant Professor; Dept of Clinical Psychology; RINPAS, Kanke, Ranchi-834006(India). Key Words: Substance dependents, Defense Mechanism

The ‘mature’ defense strategies are based on a pretty solid and accurate understanding of social reality, and tend to be more constructive and adaptive in nature. It includes sublimation, humor, affiliation, self-observation and assertiveness. Unconscious processes arise as individual’s response to the threats of change (Halton, 1994; O’Connor, 1993). Individuals unconsciously use well developed and habitual defense mechanisms to protect themselves from change and from the feelings of anxiety (Oldham and Kleiner, 1990; de Board, 1978). These defenses can sometimes obstruct and hinder an individual from adapting to change (Halton, 1994). The present study is thus an attempt to know the defenses used by the substance dependents, for their better management and relapse prevention. Methodology: Sample : A sample consisting of thirty (30) male patients (alcohol dependent-22, cannabis dependent- 5, psychotropic medicine dependent-2, brown sugar dependent-1) who were diagnosed as substance dependent according to ICD-10 criteria was taken for the study. Subjects were in the age range of 25-40 year and were educated up to 8th class (secondary level). They were selected from RINPAS and CIP, Ranchi through purposive sampling technique. Patients who had any co-morbid psychiatric disorder or having any withdrawal symptoms were excluded from the study. Thirty (30) normal controls matched with age and education were also selected from Kanke and other neighboring areas using purposive sampling. Normal subjects had no known history of substance dependence. Subjects having family history of mental illness were excluded from the normal control. Socio-demographic characteristics of subjects are given in Table 1. Tools : • Socio-demographic and clinical data sheet was developed to record relevant sociodemographic and clinical data. • Defense Mechanism Inventory (Mrinal and Mrinal,1971): It provides information about general degree of defense mechanisms used by individuals and about preferred combinations of defense mechanism. It measures five groups of defense mechanisms, namely, Reversal, Principalization, Turning against self, Projection and Turning against object which consist- reaction formation, denial, regression, repression, compensation, projection, intellectualization and displacement. Procedure : In the context of exclusion and inclusion criteria, sample was selected. Successive interviews were done and information was cross checked from case record file. Sample was selected and socio-demographic and clinical data sheet was filled. Defense Mechanism Inventory was administered individually to assess their defenses. Psychological Defenses 153

Table 1 Socio-Demographic Characteristics of the Sample S.NO VARIABLE PATIENT GROUP (30) NORMAL GROUP (30) X Age in years 25-30 0.13(NS) 31-35 36-40 Education 10th 0.04(NS) UG PG Marital Status Married 0.03 (NS) Unmarried Religion Hindu 1.8(NS) Muslim Christian Residence Rural 0.24(NS) Urban Semi urban Result and Discussion : Finding of the study is given in Table 2. The result shows that reversal and principalization are the major defense mechanism used by the substance dependent individuals. Reversal is the class of defense mechanism that deals with conflict by responding in a positive or neutral fashion to a frustrating object which might be expected to evoke a negative reaction. Defenses such as negation, denial, reaction formation, and repression are subsumed under this category. The second highest score was on Principalization (PRN), which deals with conflict through invoking a general principle that “split off” affect from content and repress the former. Finding is in accordance with the result of Aldridge et al. (1967). Defenses such as intellectualization, isolation, and rationalization fall into this category. Earlier studies showed that alcoholic personality is self destructive and orally dependent, and oriented to life (Fenichel, 1945). Substance dependent individuals are found to have low ego strength (Borowitz,1964), self destructiveness (White,1966), and dependency (Witkinet al., 1959). Other investigators (Aldrige et al., 1967) predicted that the alcoholics would be high on Reversal and turning against self and low on turning against object and principalization in comparison to normal subjects. Present study conforms the earlier findings partially. 154 Khan et al

Table 2 Comparison of Defense Mechanism in Substance Users and Normal Subjects DEFENSE SUBSTANCE USERS NORMALS MECHANISM GROUP t-Score Mean SD Mean SD Reversal 38.6 15.47 26.30 10.73 3.61* Principalization 35.1 7.88 24.46 10.2 4.58* Turning against self 22.86 8.31 20.83 9.6 .88 (NS) Projection 22.8 9.42 39.5 9.78 6.68* Turning against object 18.86 12.44 40.16 8.37 11.55* * Significant at .01 level of significance These findings reveal that the substance dependents respond in socially accepted manners and they try to hide their actual desires. They use denial and are very much manipulative. Bergman et .al (1992) found significantly more signs of projected introgression in patient with alcohol abuse, which support the findings of present study. In another study, Sundbom (1992) found a higher frequency of projected introgression in substance dependents than in neurotics and borderline patients. An earlier investigation (Aleman, 2004) on psychotic drug abusers did not demonstrate any projected introgression. These defenses are very frequently seen with inpatient substance dependents. Substance dependents are also found to rationalize their behavior and they try to show that their behavior is not due to their internal deficit rather they attribute it to external factors. They have low ego strength, self destructiveness, and need for dependency (Witkin et al., 1969) which suggests that their intake behavior is due to their impulses and rationalization. Conclusion : The findings of the study reveal that substance dependents use unhealthy defense mechanism to defend themselves. They should be helped to learn maturity and modify their defense process in order to prevent the relapses. Reference : Aldridge, R.C., Boxter,G.I., Nopziger,L.M., Roggenbuck,A.L, Shimansky,R.L., & Worthuis, D.J .(1967) Defense machanismof an alcohol population as compare to a normal population. Unpublished Master’s thesis, Michigan State University. Aleman, K. (2004) Differences in terms of the Defense Mechanism Technique modified (DMTm) between psychotic and non-psychotic drug abusers. Journal of Projective Psychology & Mental Health, 11, No 1: 25–35. Bergman, I., Bergman, H., Dahlgren, L., & Åsberg, M. (1992) Kvinnliga missbrukares psykiska försvar liknar depressiva kvinnors. Läkartidningen, 89, 32–33, 2598–2605. Borowitz, G.H. (1964) Some ego aspects of alcoholism. British journal of Medical Psychology, 37, 257-263. Psychological Defenses 155

De Board, R. (1978) The Psychoanalysis of Organisations, Tavistock, London. Fenichel, O. (1952) The psychoanalytic theory of neurosis. New York: Norton. Halton, W. (1994) Some unconscious aspects of organizational life: contributions from psychoanalysis. In Obholzer, A, and Zagier Roberts, V. (Eds) (1994) The Unconscious at Work, Routledge, London. Grohol, J. M (2007) 15 Common Defense Mechanisms. Psychecentral. www.google.com. Jacobs, J.A. (1995) The winners know how to change ± do you?’’. Hospital Materiel Management Quarterly, Vol. 16 (4), 18-24. Kyle, N. (1993) Staying with the flow of change. Journal for Quality and Participation, Vol. 16 (4), 34-42. Mrinal, N. R. & Mrinal, U. (1971) Manual for defence mechanism inventory. National Psychological Corporation, Arga. O’Connor, C.A. (1993) Resistance: the repercussions of change. Leadership and Organization Development Journal, Vol. 14 (6), 30-6. Oldham, M., & Kleiner, B.H. (1990) Understanding the nature and use of defense mechanisms in organizational life. Journal of Managerial Psychology, Vol. 5 (5), i-iv. Scott, C.D., & Jaffe, D.T. (1988) Survive and thrive in times of change. Training and Development Journal, April, 25-7. Sundbom, E. (1992) Borderline psychopathology and the Defense Mechanism Test. Doctoral dissertation, Sweden: University of Umeå, Department of Applied Psychology. White, W.F. (1965) Personality and cognitive learning among alcoholics with different intervals of sobriety. Psychological Reports, 16, 1125-1140. Wilkin, H.A., Karp, S.A., & Googenough, D.R. (1959) Dependence in alcoholics. Quarterly Journal of Studies in Alcoholism, 20, 493-504. 156 Khan et al

SIS–II Profile of Alcohol Dependence Patients Jay K. Ranjan, Anju Kumari, Dolly Kumari, Jai Prakash and K.S. Sengar Somatic Inkblot Series (SIS) has become an effective projective tool for the assessment of the patient suffering from various mental health problems and general population as well. Alcohol dependence is one of the major problems which have drawn the attention of society and mental health professionals all over the world. The present study, aims to assess the profile of alcohol dependents using SIS-II. Thirty (30) male alcohol dependent inpatients from Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS), Ranchi, India; were administered the Somatic Inkblot Series Booklet Version (SIS-II) and compared with 30 normal controls. Result reveals significant differences in Atypical, Most Typical, Typical, Sex, Anatomy, Depression and Movement responses of the alcohol dependents and normal subjects. Somatic Inkblot Series (SIS) is structured projective diagnostic instrument. SIS has been developed primarily to understand the manifestation of problem through somatization and to hear the inner cry of suffering individuals. SIS-II consists of series A and series B, each with 31 images (total 62 images). The 62- image series ranges from unstructured, semi-structured, to structured. This test is based on the theory of Somatic Imagery, Body Symbolism, Body perception and the cry for help (Cassell, 1994). Somatic Imagery theory proposes that every individual has unique and highly personalized system of attitude both conscious and unconscious, which is projected in to the body concept as spatial entity. Theory of body symbolism explains that an individual integrates mental and physical phenomena, and is based on philosophical principle of mind body relationship. Somatic Inkblot Series (SIS) has both diagnostic and therapeutic applications. It has been used extensively as a diagnostic procedure (Cassell et al., 2001, 2002; Dosajh, 1998, 1999; Dubey, 2000; Panek, 2001; Verma and Kaur, 1999). The review of literature on SIS reveals that SIS-II (booklet form) has been used on psychotics and neurotics (Pershad et al., 1997; Rathee et al., 1995, 2002), schizophrenics and depressives (Pershad & Verma, 1995), psychiatric patients (Verma et al, 1994; Singh & Dubey, 1997, Rathee et al, 1995), Speech disorder (Nehra et al., 1997), Murderer’s (Singh et al., 2000), ADHD (Jain et al., 2005), Drugs and Alcohol dependents (Singh and Dubey., 1997) and Age Related Changes (Pandey., et al 2001). Alcohol dependence is one of the major mental health problems which have drawn the attention of society and mental health professionals all over the world. However, a few studies are reported on SIS-II profile of alcohol dependents. The present study aims to assess the profile of alcohol dependents with the help of SIS-II Test. Material and Method : Sample : Based on purposive sampling technique, 30 male alcohol dependent subjects were taken from inpatient wards of RINPAS. Patients with active psychopathology, and other Jay K Ranjan, Anju Kumari, Dolly Kumari, M. Phil Scholars; Jai Prakash, Ph. D, Associate Professor; K. S. Sengar, Ph. D, Assistant Professor; Dept of Clinical Psychology. RINPAS, Kanke, Ranchi-834006 (India). Key Words: Alcohol Dependence, SIS- II profile.

neurological disorders were excluded. The normal subjects matched with the patient group were selected from Ranchi and nearby places. They were screened by using General Health Questionnaire-12. The sample characteristics are shown in Table1. Table 1 Characteristics of the sample Socio demographic details Alcoholic Patients Normal Subjects 18-30 Age (years) Age (years) Age (years) Age (years) Age (years) 31-40 Primary Education Education Education Education Education Secondary Graduate Urban Domicile Domicile Domicile Domicile Domicile Semi urban Rural Tools: The following tools have been used in the study for the purpose of data collection: • Sociodemographic Data sheet: was prepared to get the sociodemographic information of the subjects. • SIS-II (Cassell et al., 1980, 2003). SIS-II Booklet Form consists of 62 inkblots images. It is self administered test under supervised instructions. • General Health Questionnaire-12 (Goldberg et al, 1978). It consists of 12 items. The questionnaire concerns itself with two major classes of phenomena: ability to carry out one’s normal healthy functions and the appearance of a distressing nature. Procedure : Subjects were selected after screening according to inclusion and exclusion criteria. SIS-II was administered and scored following standard procedure (Cassell and Dubey,2003) after taking consent of the subjects. The SIS-II protocols were analyzed on 14 indices i.e. Total number of responses (R) , Human(H), Animal(A), Movement(M), Anatomy(At), Sex, Rejection of images(Rej), Most Typical(MT), Typical(T), Atypical (AT), Pathological Anatomy Scale(PAS), Depression Scale(D), Hostile and Aggression Scale(HAS), and Paranoia (P). The normal subjects were screened using General Health Questionnaire (GHQ-12), followed by SIS-II Test. 158 Ranjan et al

Statistics Used : Obtained responses of alcohol dependents and normal groups on SIS-II were scored and analyzed using Mean, Standard Deviation and ‘t’ test. Results and Discussion : Perusal of table 2 shows response patterns of the subjects. Findings of the study show that both the groups differ significantly on Anatomy Responses (At), Sex Responses, Movement (M), Most Typical Responses (MT), Typical Responses (T), Atypical Responses (AT) and Depression (D). Table 2 Comparison of Alcohol Dependents and Normal groups on SIS - II Indices Alcohol Dependent Normal Control ‘t’-ratio p-value Group Group Mean SD Mean SD Total no. of Response(R) 65.70 2.24 66.73 5.85 0.90 NS Human Responses (H) 18.60 4.17 20.30 4.38 1.45 NS Animal Responses (A) 8.16 5.71 10.06 5.03 1.36 NS Anatomy Responses (At) 18.93 7.34 15.13 5.64 2.24* 0.05 Sex Responses (Sx) 5.03 3.07 2.20 2.17 4.16** 0.01 Movement Responses (M) 12.03 2.07 9.73 3.51 2.35* 0.05 Most Typical 9.33 1.92 12.23 1.88 5.91** 0.01 Responses(MT) Typical Responses (T) 18.23 3.96 23.66 4.33 5.07** 0.01 Atypical Responses(AT) 37.00 4.51 30.76 6.10 4.52** 0.01 Rejection of Images 0.30 0.59 0.33 0.54 0.21 NS Pathological Anatomy 0.50 0.68 0.26 0.44 1.56 NS Scale (PAS) Depression (D) 0.43 0.62 0.16 0.37 2.00* 0.05 Hostile & Aggression 0.60 0.62 0.50 0.62 0.61 NS Scale (HAS) Paranoia (P) 0.01 0.10 0.01 0.10 0.00 NS * Significant at .05 level, * * Significant at .01 level Finding of the present study indicates that Total number of responses (R) were slightly high in normal control group (M=65.70 ± 2.24) in comparison to alcohol dependent SIS –II Profile of Alcohol Dependence Patients 159

group (M=66.73 ± 5.85) but the difference was not found statistically significant. The high number of responses(R) in both the groups indicates fair imaginative capacity and effective intelligence. Finding of the study is contradictory with the study of Singh and Dubey (1997). Obtained Human responses (H) in both groups suggest good interpersonal relationship with others. It seems that the alcohol has not deteriorated their interpersonal relationship and imaginative ability. The fact is further supported by the low number of Animal responses in both the groups. Table 2 further reveals that Alcohol dependent subjects perceived more Anatomical (At) percept (M=18.93 ± 7.34) in comparison to normal control subjects (M=15.13 ± 5.64) and the difference is significant at 0.05 level (t=2.24, p< 0.05). This indicates that alcohol dependent subjects are preoccupied with their somatic symptoms and internal body organs. This may also indicate their anxiety and concern about their health. Similar findings have been reported by Singh and Dubey (1997) on alcohol addicts. High number of Sex responses in alcoholic group (M=5.03 ± 3.07) as compared to normal control group (M=2.20 ± 1.62) was found to be significantly different at 0.01 level (t=4.16, p<0.01). The findings may indicate sexual preoccupation/ anxiety towards normal physical relationship in the alcohol dependence group. The Alcohol dependents showed significantly high number of Movement (M) responses (M=12.03 ± 2.07) in comparison to normal subjects (M=9.73 ± 3.51) and the difference was found significant.(t=2.35, p<0.05). This might indicate that alcoholic group of this study are able to utilizes available resources to cope up with the demand of the situation. This may also indicate that they are active, able to maintain functioning intelligence and may get benefit from therapeutic intervention. It is further supported by high productivity and human responses in alcoholic subjects. Most Typical responses (MT) are suggestive of coherent, logical thinking, and ability to keep up with the demands of society. It may also be interpreted as a measure of ego strength and team concept. These responses were found significantly low in alcoholic group (M=9.33 ± 1.92) than that of normal subjects (M=12.23 ± 1.88) and difference is statistically significant at 0.01level (t=5.91, p<0.01). The finding is also consistent with the findings of earlier study on drug addicts (Singh and Dubey, 1997, Arora, 1982). The alcoholic dependents have scored high on Atypical responses (M=37.00 ± 4.51) than normal subjects (M=30.76 ± 6.10) and the difference was found to be statistically significant. (t=4.52, p<0.01). It is also clear from Table 2 that alcohol dependence group (M=18.23 ± 3.96) perceived significantly low number of Typical (T) responses than normal 160 Ranjan et al

group (M=23.66 ± 4.33, t=5.07, p<0.01). This may further support poor quality and bizarre thinking of alcoholic subjects. Rejection of images were low in both the groups suggests that no serious psychopathology is working behind the use of Alcohol. This is a good sign of prognosis and therapeutic intervention such as Cognitive Therapy and Supportive Family Therapy will be of much help to Alcoholic group. On Pathological scales, Mean number of Responses is less than the Standard deviation may indicate that only a few subjects have shown depression, Hostility and aggression and Pathological Anatomy so it does not warrant any explanation. However, Depressive symptom have been reported in an earlier study on heavy drinkers of alcohol produce (Hesselbrock et al. 1992) Conclusion: Significant differences in some of response patterns on SIS-II were found when alcoholic group was compared with normal group. Profile of the alcoholic dependents indicates that they vary on Anatomy Responses (At), Sex Responses, Movement (M), Most Typical Responses (MT), Typical Responses (T), Atypical Responses (AT) and Depression (D) with the normal population. The Alcoholic group had significantly higher Anatomy (At), Sex (Sx) and Atypical Responses (AT), and significantly low on Most Typical Responses (MT) and Typical Responses (T). Overall SIS-II profile of alcohol dependent patients indicate that they are having somatic preoccupation, anxiety regarding sexual dysfunction and low ability to keep up with the demands of society. References : Arora, U. (1982). A Rorschach study of alcoholics. Indian Journal of Clinical Psychology, 9, 141-145. Cassell, W.A. (1980). Somatic Inkblot Series-II. Aurora Communication, Inc. Cassell, W.A. (1994). The Somatic Inkblot Series: Continuing Rorschach’s Conceptualization, SIS. Journal of Projective Psychology & Mental Health, 3: 3-32. Cassell, W.A. and Dubey, B.L. (2000). Inkblot Responses as an Aide to Therapy. SIS Journal of Projective Psychology & Mental Health. 7(1), 3-10 Cassell, W.A., Ilardi, F.J. Collins, A, Mishra, M and Dubey, B.L. (2001). Optimizing Spiritual Healing by Assessing Dream and SIS Imagery. SIS Journal of Projective Psychology & Mental Health, 8(2), 75-94. Cassell, W.A., Schaeck, A.M. and Mohn, D. (2002). Symbolism in Violent Hallucinations. SIS Journal of Projective Psychology & Mental Health.9 (2), 81-92. Cassell, W.A., and Dubey, B.L. (2003). Interpreting Inner World Through Somatic Imagery: Manual of Somatic Inkblot Series. SIS, Centre, Anchorage: Alaska (USA). Dosajh, N.L. (1998). Use of SIS-II and Other Projective Test in the Treatment of a Case of Schizophrenia. SIS Journal of Projective Psychology & Mental Health. 5(1), 46-50. SIS –II Profile of Alcohol Dependence Patients 161

Dosajh, N.L. (1999). Maintaining Mental Health of the Aged through Psychosynthesis. SIS Journal of Projective Psychology & Mental Health. 6(1), 58-60. Dubey BL (2000). Editorial: SIS Technology in millennium 2000. SIS Journal of Projective Psychology & Mental Health, 7(2), 91-92. Goldberg D., & William P. (1978). General Health Questionnaire- 12, Published by NFER- NELSON Publishing Company Ltd., Berkshir, UK. Jain, R., Singh, B., Mohanty, S.R., and Kumar, R. (2005). SIS-I and Rorschach Diagnostic Indicators of Attention Deficit and Hyperactivity Disorder. SIS Journal of Projective Psychology & Mental Health, 12(2): 141-152. Hesselbrock, V.M., Meyer, R.E., and Hesselbrock, M.N. (1992) Psychopathology and addictive disorders: The specific case of antisocial personality disorder. In: O’Brien, C.P., and Jaffe, J.H., eds. Addictive States. New York: Raven Press, 179–191. Nehra, A., Raghunathan, M., Verma, S.K., and Mann, S.B.S. (1997). Recognition of Psychological Problems in Patients suffering from Speech Defects with the help of SIS-II. SIS Journal of Projective Psychology & Mental Health, 4, 1431-151. Pandey, R., Tripathi, V., and Tripathi, S. (2001). Age Related Changes in SIS – II Response Contents. SIS Journal of Projective Psychology & Mental Health, 8(1): 35-40. Panek, P.E., Skowronski, J.J., and Wanger, E.E., (2000). The Effects of Age and Gender on Hand Test Responses of Chronic Pain Patients. SIS Journal of Projective Psychology & Mental Health, 7(2), 109-117. Panek, P.E. (2001). Editorial: Projective Psychology in the New Millennium: Issues and Challenges. SIS Journal of Projective Psychology & Mental Health.8 (2), 73-74. Pershad, D., and Verma, S.K. (1995). Diagnostic Significance of Content Analysis of SIS-II. SIS Journal of Projective Psychology & Mental Health, 2(2), 141-149. Pershad, D., Verma, S.K., and Bhagat, K. (1997). Body Image Disturbances in Psychiatric Cases. SIS Journal of Projective Psychology & Mental Health, 4, 75-84. Rathee, S.P., Pande, V., and Singh, A. (1995). Diagnostic Efficacy of Somatic Inkblot Series-II Among Psychiatric Patients of Armed Forces. SIS Journal of Projective Psychology Mental Health, 2(1), 61-66. Rathee, S.P., Pardal, PK., and John, TR. (2002). Diagnostic value of SIS-II Among Sub-groups of Psychotic and Neurotic Patients of Armed Forces. SIS Journal of projective Psychology and Mental Health, 9(1), 23-32. Singh, A.R., and Dubey, B.L. (1997). SIS-II Profile of Drug and Alcohol Dependent Cases. SIS Journal of Projective Psychology & Mental Health, 4(1), 56-59. Singh, A.R., Dubey, B.L., Sahu, L.M., and Banerjee, K.R. (1997). Prognostic utility of Somatic Inkblot Series –II. SIS Journal of Projective Psychology & Mental Health, 4(2), 141-144. Singh, A.R., Dubey, B.L., Sahu, L.M., and Banerjee, K.R. (2000). SIS-II Profile of professional Murderers. SIS Journal of Projective Psychology & Mental Health, 8(1), 28-30. Verma, S.K., Pershad, D., and Nehra, R. (1994). Cross-validation of SIS-II in Psychiatric Population. SIS Journal of Projective Psychology & Mental Health, 1, 15-18. Verma, S. K., & Kaur, H. (1999). A Proposed Model for Quantification of Abnormal Somatic Concern on SIS-II. SIS Journal of Projective Psychology & Mental Health, 6(1), 65-68. 162 Ranjan et al

Important Announcement Dr. Amool Ranjan Singh, Ph.D., Professor and Head, Department of Clinical Psychology, RINPAS, Kanke, Ranchi - 834 006 (India) E-mail : sisamool@yahoo.com editor_sis@rediffmail.com 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 Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834 006 (India) The Subscription Cheque should be made in favour of “SIS Journal of Projective Psychology & Mental Health” payable at Ranchi (India)

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STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. India PERIODICITY OF PUBLICATION : Half Yearly EDITOR’S PRINTER’S Name : Amool Ranjan Singh PUBLISHER’S NATIONALITY : Indian ADDRESS : Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006. India OWNER : SOMATIC INKBLOT SOCIETY I, Dr. Amool Ranjan Singh, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. Amool Ranjan Singh, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Published by Dr. Amool Ranjan Singh on behalf of Somatic Inkblot Society at Annapurna Press & Process, Near Income Tax Office, 5, Main Road, Ranchi-834 002, Jharkhand (India), Ph. : 2331800 Editor-in-Chief : Amool Ranjan Singh

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Abstracted in “APA’s Psychological Abstract” Regd. No. 71632/99, RNI Delhi SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH (OFFICIAL JOURNAL OF SOMATIC INKBLOT SOCIETY) EDITORS EMERITUS : Wilfred A. Cassell, MD, Director, SIS Center, 4501E, 104th Avenue, Anchorage, AK.99516 (USA). E-mail: siscassell2@yahoo.com : Bankey L. Dubey, Ph.D., Director SIS Centre, 4406 Forest Road, Anchorage, AK 99517 (USA) E-mail: sisdubey@rediffmail.com, bldubey@gmail.com, cell : 907-223-1088, Tel: 907-248-2256. EDITOR-IN-CHIEF : Amool Ranjan Singh, Ph.D. Prof. & Head, Dept. of Clinical Psychology, RINPAS,Kanke,Ranchi-834006 (India). Tel. : 91-651- 2233687(H), Mob.:91-9431592734, E-mail:sisamool@yahoo.com EDITORS : Suprakash Chaudhury, MD, Ph.D., Prof. & Head, Dept. of Psychiatry, RINPAS, Kanke, Ranchi-834006 (India). Mob.:91-09334386496, E-mail : suprakashch@gmail.com : Anand Dubey,B.E., MBA, SIS Centre, 4406 Forest Road, Anchorage, AK 99517 (USA), E-mail: anand.dubey@gmail.com : Padma Dwivedi, M.A., 4406 Forest Road, Anchorage, AK 99517 (USA), E-mail : sisdubey@yahoo.com : Jai Prakash,Ph.D., Associate Professor of Clinical Psychology, Dept. of Clinical Psychology, RINPAS, Kanke, Ranchi - 834006, (India). Cell: 91-9934582290, E-mail : drjaiprakashrinpas@rediffmail.com : Umed Singh, Ph.D., Dept. of Psychology, Kurukshetra University, Kurukshetra, Haryana, (India). E-mail : Umedsingh_78@yahoo.com. Tel: 91-1744-238267(H), Cell: 91-9416511077 EDITORIAL CONSULTANTS Kristian Aleman, Ph. D., Sweden John Baby, Ph.D., India K.R.Banerjee,MRCP, India N. G. Desai, M. D., India Mahesh Bhargava, Ph.D., India Saugata Basu, Ph.D., India Carina Coulacoglou, Ph.D., Greece Philip Greenway, Ph.D, Australia D. K. Giri, M.D., India M. Jahan, Ph.D., India Arvind Keshary, Ph.D, India Anatoly B. Khromov, Russia R. Kumar, Ph.D. India Devvrat Kumar,Ph.D.India Sudhir Kumar, M.D. India RamJee Lal, Ph.D.India Anu S. Lather, Ph.D., India Lisa Milne, Ph.D., Australia Mridula Mishra, Ph.D., India Nalini Mishra, Ph.D., India D. K. Sharma, MHA, India A. S. Kundu, Ph.D., India Kalpana Srivastava, Ph.D., India Paola Nicolini, M.A., Italy Paul E. Panek, Ph.D., U.S.A. Edward M. Petrosky, Ph.D., U.S.A. Marisa Porecca, Ph.D., Italy Stefano Reschini, M.A, Italy Barry A. Ritzler, Ph.D., U.S.A. D. Saldanha, M.D., India Nilanjana Sanyal, Ph.D., India T.R.Shukla,Ph.D.India Radhe Shyam, Ph.D.India Archana Singh, Ph.D., India R.N. Singh, Ph.D., India David Sperbeck, Ph.D., U.S.A. Ajay K.Srivastava, Ph.D., India Ramjee Srivastava, Ph.D., India K. S. Sengar, Ph.D., India Ailo Uhinki, Ps.D., Finland Yasho V. Verma, Ph.D., India (07/08) Annapurna, Ranchi, Ph. : 2330875, 2331800