SIS Journal of Projective Psychology & Mental Health

Journal of Projective Psychology & Mental Health Volume 21 Number 2 July, 2014 ISSN 0971-6610 SIS Official Publication of the Somatic Inkblot Society Editorial : Religious Symbols and Astronomical Projections Wilfred A. Cassell 65-67 SIS Incites Long Term PTSD Combat Memories and Survivor Guilt Wilfred A.Cassell, Tyrone Charles, Bankey L. Dubey and Halia Janssen 68-80 Gender-Specific Personality Differentials of Suicide Ideation among Adolescents Umed Singh and Kamlesh Rani 81-89 Transference and Equal Status Transference: A Relational Probe into Sibling Jealousy Nilanjana Sanyal 90-97 Early Abusive Experiences and Psychological Consequences: a Study with Institutionalized Children. Pritanka Mondal and Sanjukta Das 98-103 Stress, Coping and Emotional Processing in Chronic Pain: A Comparative Analysis Ushri Banerjee, N.K. Bhattacharya and Nilanjana Sanyal 104-112 Effect of Age and Education on SIS-II Percepts Nidhi Verma and Umed Singh 113-118 SIS-II Profile of Patients with Thalassemia S.K.Bhogta, S.Roy, M.Jahan, K.S.Sengar and A.R.Singh 119-121

SIS Somatic Inkblot Society OFFICE BEARERS Executive Members : Mike Baker, MBA. Wilfred A Cassell, M.D. Mary Cassell, M.A. Anand Dubey, MBA. Satchit Mandal, M.A. Tilottama Mukherjee, Ph.D. Preety Pandey, M.A. Ajay Tiwari, Ph.D. Pragya Tiwari, MBA. Sambhu Upadhyay, Ph.D. President :Bankey L. Dubey, Ph.D. Editor In Chief: Rakesh Pandey,Ph.D. Vice President : Brig. D.Saldanha Gen. Secretary :Nalini Mishra, Ph.D. Joint Secretary: Akansha Dubey, M.A. Treasurer :Padma Dwivedi, M.A. 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 behavior. The journal includes (a) research articles (b) book reviews (c) brief reports (d) news about conferences and letters to the editor. MANUSCRIPTS PREPARATION Manuscripts should be typewritten (single-spaced throughout) submitted through E-mail to B.L. Dubey, Ph.D. Editor Emeritus, SIS Journal, E-mail:bldubey@gmail.com with a copy to Rakesh Pandey, Ph.D., Editor in Chief, SIS Journal, Prof. & Head, Dept of Psychology, BHU, Varanasi-221005, E-Mail: rpan_in@yahoo.com. The Editors reserve the right to refuse manuscript submitted and to make minor additions/deletions. Authors should prepare their manuscripts according to the Journal of Personality Assessment/ 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. 1000, for Indian members. Institutional subscriptions are US $100 for Foreign institutions and Rs.1500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 5000/- for Indian members. Indian institutional life membership is Rs. 10,000/-. Non-members may subscribe for $45 or Rs.600 per issue. Subscription can be made by electronic bank transfer to Punjab National Bank, in the SIS Journal's account given below: Name of Account: SIS Journal of Projective Psychology & Mental Health Bank Name: Punjab National Bank, Bhikharipur Branch, DLW- Kakarmatta Road, Varanasi -221004 Account No. 4045000102207342, (IFS Code: PUNB0404500) Subscription can also be made thru cheque, payable in favor of “SIS Journal of Projective Psychology & Mental Health” and mail to Editor in Chief's address at Varanasi. CHANGE OF ADDRESS Members should inform B.L. Dubey, Ph.D, Director SIS Centre, Email:bldubey@gmail.com of any change of mailing address. Copyright @1994. SIS Center, India/Anchorage Website: http://www.somaticinkblots.com

Please be forewarned. This editorial may activate introspective spiritual connected cognitions having neurophysiologic linked emotionally charged memories. These may prove potentially psychospiritually disturbing! In completing the following mental exercise, it might be subjectively helpful to keep in mind the philosophical law: “No pain, no gain”. Let us as researchers, clinicians and SIS Body-Mind- Spirit theoreticians be introspectively courageous, as we examine the currently unknowable infinite like boundaries of our human “Body-Planet-Cosmos enclosed ego/spirit”. Since what astronomers refer to as the “Big Bang” origin of the Cosmos, human life represents a mere flash in a geologic time scale. I now invites you to pause, withdraw attention from the outer world of social reality. When subjectively ready, then enter your private psychic world by personally meditating. Next, if you benefit internally from a rich religious foundation, activate this personal positive affect linked spiritual imagery in conscious awareness, subjectively utilizing its faith based religious symbols. Hopefully these Body-Mind-Spirit preliminary exercises have now created an optimal subjective state for personally preparing for directly perceiving the “Face of Ultimate Death Without Blinking”! Remember to ignore any negative thoughts/emotions if they attempt to encroach on your positive experience in your God given introspective inner world. Always be optimistic about the multiple benefits from such meditation. Afterwards recall the ever more fascinating state of the art SIS electronic diagnostic/treatment technology currently under clinical research development. However, this editorial invites each reader to primarily focus on “Death Dogma”. Editorial Religious Symbols and Astronomical Projections Wilfred A. Cassell Focusing on issues related to SIS stimulated spiritual imagery has a sound scientific historical basis. It may be recalled that in the manual for SIS-I entitled “BODY SYMBOLISM” first published in 1980 there was a chapter entitled “Death Anxiety”. It began with the observation that “Humans appear to be the only creatures with a fear of death”. In this connection, it provided clinical evidence regarding the diagnostic/treatment use of the SIS-I. However “Death Dogma” in regard to the role of organized religion was only briefly discussed. The chapter on sexuality also introduced the use of the SIS in exploring psychological defense mechanisms based on projected religious symbolism. The latter presented data indicating that certain subjects who were anxious while viewing inkblot structure suggestive of the female genitalia defended against recognizing the embedded somatic content by projecting the Christian symbol of “Jesus on a cross”. As a result of clinically based phenomenological oriented observations, it was then concluded that “Religious defenses can be healthy when they assist the individual in guarding against socially unacceptable behaviors, but they can be unhealthy when they inhibit or interfere with optimal sexual functioning”. In addition, this journal has presented several studies concerning the intimate relationship between sexuality and spirituality through dream image linkage. Appropriate SIS stimulated spiritual dream therapy may provide an effective adjunct to traditional treatment procedures. The above studies now set the conceptual stage for a theoretical formulation of “Death Dogma” religious symbolism based upon 21st century SIS projective theory. Recall the use of Content Analysis for the Rorschach test, when scoring for projected imagery depicting “Human” content. Then for the purposes of transferring this projective procedure's theoretical foundation in an analogous fashion to the early Roman and Greek astronomers who named celestial bodies (e. g. “Jupiter”- the largest planet was named after the supreme god of the Roman pantheon “Venus - the god of love and beauty, “Mars” - the god of war etc.). In this SIS J. SIS J. Proj. Psy.&Ment. Health (2014) 21:2, 65-67

perceptual model, for them the night sky was full of Rorschach inkblot like ambiguous shapes. These provided ambiguously structured flickering visual stimuli onto which they projected their body-mindspirit fantasies. As illustrated, many of their “Celestial Inkblots” were said to resemble Gods in human like form. Next imagine how even earlier cultures having intelligent, but still astronomically naïve illiterate viewers interpreted the solar system objects in their visual field. One example involves the Stonehenge people 4000 to 4500 years ago. The reader might consider how such folks might similarly use the mental mechanism of projection to cognitively support irrational, yet emotionally comforting positive fantasies regarding their crops and birth cycle. Moreover they enriched their primitive religious projections with the fantasy of a “Living Spirit” moving out of the deceased person's body to be magically stored in architecture, that is illustrated in Figure one. They had created in what at the time was a comparatively advanced cooperative social system on our planet earth. Archeological research suggests that they planned for this form of storage until release to their sun god exactly when the rays of sunshine accurately moved down a precise solar aligned constructed architectural passage at the equinox. With regard to the deceased souls, this simultaneously defended them from there sense of loss and as well their own “Death Anxiety”. It might be noted that their positive religious based culture ultimately fell victim to invading warriors who possessed superior weapons of metal. (One fears that this historical principle “Military Might over Right” as a truism will be again repeated in the 21st century.) Many centuries later, more advanced religious doctrine incorporated the following notion: that beyond having an omnipotent Divine human like power figure in the fantasized beautiful “Heaven”, there was envisioned a God representative human living on earth. Since I am more familiar with Christianity, this will be the major religion to be examined through the conceptual lens of SIS theory. In this particular illustration, the historical leader selected was Jesus Christ. He is said to have been born of 66 Cassell a virgin mother and suffered for mankind's sins. He was crucified on the cross 2014 years ago and shortly afterwards on Easter was resurrected. His resurrection is claimed to offer the hope to all Christians of having their sins on earth forgiven and like him an opportunity to survive spiritually after their body's demise. In this religious symbolic model, ultimately their souls are imagined to be transferred after death to a beautiful fantasized space. This was envisioned somewhere hidden in the sky spatially located in the yet structurally undefined location in “Heaven”. Their adherent's religious art depicted bestial loving “Angels” (i.e. humanoid forms with wings) to fly them after death to their sky extraterrestrial spatial spiritual setting promising loving intimacy with God. Eventually this hopeful but to atheists irrational view was refined by various Christian groups. In the modern world the largest being the Roman Catholic Church. Their clergy eventually established a power hierarchy having publicly celibate male clergy, with the most spiritually powerful person the omnipotent Pope, who was in the early church claimed to be “infallible”. In regard to their religious projections, it may be recalled how rigidly the Catholic clergy asserted their astronomical ignorance and held empowered authoritarian murderous views. They insisted that our planet earth was both flat, as well as the center of the universe. Recall that certain original astronomers, such as Copernicus paid with their lives as victims of sadistic murder for asserting more reality based astronomical thinking. For the sake of historical authenticity, it must be recognized that years later the modern Catholics in Rome issued a public apology for committing the above outlined historical crime. Being previously publicly humiliated by their scientific ignorance, certain more scientifically oriented members (e.g. Jesuits) currently scan the Cosmos with their own modern telescopes. In the 21st century the “Death Dogma” spiritual foundation of this now internationally powerful religious/political/economic organization is being challenged. As an economic example, in Alaska this organization pays limited taxes (e.g. to support mental health services) yet is the second biggest employer). Moreover currently in the modern world young people

are avoiding seeking celibate roles of religious service in clergy operated schools. Consequently today's Catholics are approaching voters to obtain state legislation to pay their religious schools that support their particular interpretation of Christian Dogma and symbolism. Apart from the above, these male religious scholars in there tiny Italian Rome based country have more fundamental challenges. Some of these relate to the rising power of women worldwide. Many women would prefer that they would be on the top of the social power scale like tribe of Lemurs are in Madagascar. Concurrent with this, certain female clergy are pressing for more meaningful religious roles traditionally fulfilled by men. Now even more challenging to fundamental Catholic dogma is an argument proposed by intellectually empowered Catholic nuns. They psychologically project the image of a feminine persona on the divine image of God, as a “Maternal” rather than “Paternal” humanoid projection There are a multitude of related complex, potentially inflammatory, religious issues too complex for review in this brief editorial. Yet it remains a challenge for so motivated SIS scientists to professionally move beyond traditional clinical issues. Our technology and in-depth knowledge foundation enables us to assist those open minded religious scholars to scientifically sort out the positive spiritual content from the negative. Those contemplating this challenge are advised to prepare for “Facing the Rage” of clergy, who preach “The love of Jesus” but, who when aspects of their dissolving dogma are found false, generate “Hate” in their hearts. . Lastly, the following simple and brief “Poem” is presented to resonate with the pessimistic thinking of those readers who are confirmed atheists: “THEY SAY THERE IS PIE IN THE SKY WHEN YOU DIE BUT IT IS A LIE!” (Note: While the author does not believe that there is “Pie in the sky”, one is hopeful about the possibility of some basic validity to religious dogma of the world's great organized religions.) Apart from exploring the validity and efficacious aspects of religious symbols and rituals, there are many other ultimate issues warranting open minded scientific study faced by members of our SIS society. For example, an existential problem faced by all involves contemplating the time limited nature of human life, one's own body's aging and inevitable death. Another highly stressful life situation pertains to that of inevitably having to endure experiencing the demise of your loved ones (fellow humans and sometimes for those with psychobiological sophistication, grief secondary to the loss of the loving spirits residing in certain other close animal friends). On a much more grandiose Cosmic time scale, the serious philosophical SIS scientist needs to contemplate the potential impact on a human's sense of identity, as the astronomers now predict sooner or later the discovery of other forms of intelligent life in the Cosmos. In a related fashion to this discovery, since the release of extensive data concerning Americans was released into space by Voyager I and II, theoretically aliens with super weaponry might decode the message and visit our planet acting in a warlike fashion. Finally for futuristic thinkers, the astronomer predicted demise of our solar dependent planet also provides substance for “Nightmares”. In a more realistic fashion, I propose that a pressing goal for our SIS Society involves the future development of valid “Diagnostic” population screening scales to aid government authorities in identifying deranged “Borderline” psychotic religious terrorists. This form of “Preventative Medicine” needs serious immediate consideration. It appears that our planet has become flooded with loosely controlled weapons of mass destruction. Let us act now! Wilfred A Cassell, M.D., FAPA, APC. Editor Emeritus, SIS J. of Proj. Psy.& Mental Health, Director, SIS Center,4501E, 104th Avenue, Anchorage, AK - 99507 (USA) E-Mail: siswilfredacassell@yahoo.com Religious Symbols and Astronomical Projections 67

SIS Incites Long Term PTSD Combat Memories and Survivor Guilt Wilfred A.Cassell, Tyrone Charles, Bankey L. Dubey and Halia Janssen Because of the abundant opportunity for seclusion in beautiful natural settings highly conducive to bodymind-spirit healing, many COMBAT TRUAMATIZED military veterans settled in Alaska. This remote region enables such sufferers to subjectively experience the healing power of solitude in Nature. Now such settings shrink on our ever more populated, environmentally fragile, small planet Earth. Moreover Alaska provides space for those human critters who are uniquely endowed with the mental ability to think beyond the restrictive envelope of cognitively correct rational thinking. For such spiritually blessed transient travelers in geologic time, it provides a beautiful setting for optimizing their hope for achieving psychic connection to higher spiritual powers beyond earth in the Cosmos. Examples of highly hypnotic healing times occur in Alaskan winters during the full moon and also in viewing the magical moving colored “Northern Lights” or Aurora Borealis. Yet venturing into remote northern areas sometimes exposes a sufferer to life threatening outdoor events. In combat stress susceptible individuals, long dormant war induced Posttraumatic Stress Disorder (PTSD) phenomena may be transiently reactivated by stressful later life events. This case study serves to illustrate this phenomenon. In addition, it illustrates the projective manner in which the SIS can bring into focus “Empathetic Traumatization” produced secondarily from witnessing the suffering and combat induced death of others. The authors advise each reader to be prepared for empathetically peering into the present and past inner world of a chronically suffering sixty four year old man. Kindly keep in mind that in our present state of knowledge, the terminology and body-mind-spirit theoretical constructs are lacking a solid scientific statistical basis. To achieve this will require the collaborative efforts of a multidisciplinary team of future SIS scientists. The present case history employs a phenomenological descriptive approach. It involves a near fatal Alaskan Brown bear attack experienced in 2013 by a Vietnam veteran. Years ago had been had been severely stressed on two separate combat occasions. These occurred when the helicopter in which he was riding shot down. While he survived two of these near death crashes physically, as a result of these, as well as experiencing the combat deaths of comrades, he ultimately developed deep seated PTSD suffering. Gradually (without therapy) over the years, his subjective awareness of such discomfort faded in intensity. Eventually after the war, he was able to work as a mechanic, get married and relocate to Anchorage Alaska. In December 2013 at a social function, he spontaneously shared a dramatic highly stressful adventure with one of the authors (Wilfred A. Cassell). It involved a near fatal Alaskan Brown bear attack experienced the previous September when hunting alone in a remote region. When asked to later participate in a recorded Somatic Inkblot Series (SIS) educational recorded interview, both the veteran and his spouse (who had heard him reliving combat trauma in PTSD dreams) agreed. Form of SIS-II Series Selected: The STAMP form of the sixty two “Inkblot” series presents to the viewer's visual field the colored sixty two The case study involves a near fatal Alaskan Brown bear attack experienced in 2013 by a Vietnam veteran, who had been severely stressed on two separate combat occasions during Vietnam War. These occurred when the helicopter in which he was riding shot down. While he survived two of his colleagues crashed near death. He also experienced the combat death of comrades which ultimately led to developed deep seated PTSD suffering. Gradually (without therapy) over the years, his subjective awareness of such discomfort faded in intensity. Eventually after the war, he was able to work as a mechanic, got married and relocated to Anchorage Alaska. In December 2013, he shared a near fatal Alaskan Brown bear attack experienced the previous September when hunting alone in a remote region. The Somatic Inkblot Series (SIS) helped him in reliving combat trauma in PTSD dreams. The interview through Somatic imagery is discussed in the case study. Wilfre A. Cassell, MD, APC, FAPA, Tyrone Charles, Bankey L. Dubey, Ph.D., (Correspondingauthor, Email: bldubey@gmail.com), Halia Janssen and Logan Wrigley, SIS Center, Anchorage, AK 99503 Key Words: Combat Memories and survivor Guilt, SIS in PTSD.

SIS-II “Inkblots”. These are about the size of postage stamps, mounted on firm easy to hold in one hand plastic sheet. While this version of the SIS lacks the “Projective pulling power” of the hypnotic electronic forms, it is much less likely to bring to conscious awareness traumatic affect charged memories. To recall these might potentially be emotionally too painful for a viewernot in psychotherapy. Moreover in rare instancesof potentially unstable “Borderline psychotic individuals”, it reduces the risk of stimulating affect flooding and further cognitive unravelling. Transcript of the follow-up interview: Dr. C: John, recently you briefly outlined a scary story of a bear attack that you survived last fall. Please elaborate with more detail upon your reactions to inform those who care for victims of severe psychological trauma? John: You want me to give the detail of the bear attack? Dr. C: Yeah. John: Well, we had gone up to our normal hunting area that we'd been hunting in for years, and we could not get across the river so we stayed on this side of the river and started hunting there, waiting for the water to go down to get across. And I went down to a lake where we normally go. Dr. C: And this was about what time of year in Alaska? John: September the (His wife, Barbara, who was present in this educational interview commented “the 11th”). Dr. C: What was the weather like on that day? John: It was a little chilly, and ... and just a mild ... a little wind, not very much. Anyway, I went to the lake. I had a tree stand there I put there many years ago. And... Dr. C: How big is the lake? John: It's about probably half a mile long and 400 yards wide. Dr. C: And was it ... what was the ... was it sunny or was it overcast? John: I think overcast. Anyway I parked my six-wheeler machine on the trail, and I got off my six-wheeler. Dr. C: Yeah. And you were right there hunting? Hunting ...what were you hunting for? John: Moose hunting. I went into the head of the lake there to... I was going to go up on the edge of the hill. I had shot a moose up on the edge of that hill a good many years ago and the wind was blowing...I do not hear out of my left ear...I've been deaf in that ear all of my life since a kid...And never ... never heard anything coming at all! And then I looked and here's this ... this bear to my left, about twenty feet, and she's snapping her mouth, bambam-bam-bam-bam. She's not charging, but she's in a brisk walk right toward me! Dr. C: She was sending you a message, and what was it? (Laughter from Barbara) John: I suppose to get ... get your butt out of here! Anyway I realized she was not going to stop. And I turned and fired my rifle from the hip. Dr. C: And what kind of a gun were you carrying? John: A 375 H&H Bag. Dr. C: That's a big caliber gun, right? John: I ... I think I hit her low in the front shoulder. It turned her. She was probably eight to ten feet from me when she turned, and she started back toward the mountain. And as she turned toward the mountain, I heard noise to my right. And as I turned to my right, there were two cubs there coming at me from the right side! Dr. C: She had some helpers! John: Yes, she did. Dr. C: And how did you feel at that point? John: I got ... actually I got nervous and ...and scared. I did! Dr. C: I hope so! Barbara: I know you referred to them as cubs, but they were really..... John: Well, yeah, they were three or four-year-old cubs, they..... Dr. C: But weighed..... John They were probably 400, at least 375, to 400 Combat Memories and survivor Guilt 69

pounds, and they were..... Dr. C: They were huge! John: Yeah, they were..... Dr. C: In the Lower 48..... John: Three, four-year-olds Dr. C: They would be considered a big bears. John: Correct. Dr. C: So you had three bears that charged you at one time? John: Yes. They were coming right at me, and the same ... same thing! They were between ten and twelve feet from me, and I fired a round at them. They turned and went toward their mother up the hill. Dr. C: Now, when you fired the round, you weren't trying to hit them, you were just scaring them? John: Exactly. Dr. C: Yeah. Well..... John: With that round I fired..... Dr. C: Let me shake your hand, because you're a good man. You could have shot the cubs, but you didn't. John: I fired in ... to ... to try to turn them. Dr. C: Right. John: That was my intent, so..... Dr. C: That took some courage! John: It's kind of funny, because a year ago I got a new right knee, and I don't even remember running to my machine, but when the bears turned, I ran to the machine, and I was to my machine like right now! And as soon as I got on that machine, I started crying. I have never ... I've ... I've been scared in my life, but I've never ever had anything that scared me that made me cry. And it flat made me cry a lot! (Unlike in combat, in the privacy of Nature, he was able to discharge his pent up emotions from this near death through the psychophysiological release of crying.” Dr. C: What was going through your mind as you were crying? John: I ... I really don't remember at ... at the moment, you know. I don't. I was just I guess thankful to ... I ...I'm getting away! Dr. C: Uh-huh. John: You know. They didn't get me I guess is what I was ... I'm getting..... Dr. C: Can you remember what you were feeling before you started crying then? What degree of fear did you have? John: Oh, it was ... I felt ... to be honest with you, I really thought ... I was fixed to get eaten. I did. I thought I was going to be bear food, I really, really did! Dr. C: You know, you're a good guy and a friend, so I can say this, I'd hate to have a good bear get indigestion from eating an old guy like you. (Laughter of John & his wife) John: Yeah. Anyway I got up to the machine and looked my neighbor here where he was at...He was about half a mile from me, or a little less ... And he goes, good God! Did you see a ghost or what? Dr. C: So I wonder??? John: You know... Dr. C: What you were looking like at that time? John: I was just upset, you know Barbara: Well, you were, he was still pale! Dr. C: Pale, yeah. John: Uh-huh. (Affirmative) Barbara: He was still pale! Dr. C: Did you see him at that point? Barbara: I saw him just a few minutes after that, and he was pale! Dr. C: Okay. Well, let's hear more from you what was he like? Barbara: Well, he came (Speaking softly and becoming overtly anxious as a result recalling her husband's near death experience.) Dr. C: Nice and loud, please. (For the recorder) 70 Cassell et.al.

Barbara: He came into the store a few minutes after he had met up with ... with the neighbor, and..... Dr. C: This is a rural store; this isn't.....like downtown Chicago. Barbara: No, hardly. It's really rural. There were a couple other people in the store. Dr. C: Where hunters meet in the fall and so on? Barbara: Yeah. Yeah, and you can get supplies. Anyway we were in there celebrating somebody's birthday, and he shows up, and ... and he was really, really, really upset!!! He -... he looked like ...like he'd seen a ghost. And, you know, he was all misty-eyed, and he was shaking, which I've never seen him do that before. I mean, he was ... he was just, you know, on I guess on an “Adrenalin overload”. Dr. C: He had looked death in the face! Barbara: Yep. And ... and then he said a few things, and then he kind of bolted out of the store. He ... he didn't even want to be around anybody any more. He just went back where ... where we were staying, and kind of sat at the table. And I didn't really realize what had happened. It kind of took a moment to sink in, and then I went and sat with him. Dr. C: I'm glad you were there. I'm glad you were there Barbara. Dr. C. (Turning towards John) what were you feeling in the store? John can you sort of put words on that? John: I guess ... I guess I felt that I was safe, and that I was so thankful to be safe. Dr. C: Now, some people in a highly stressful situation, I don't want to embarrass you, you have bodily changes, you know. Did you have any of those? John: No. Dr. C: Okay. Well … okay. John: No. I didn't … had..... Dr. C: Your heart … what?? John: None of those. Dr. C: Your heart must have been pounding, wasn't it? John: Oh, it was ... it was getting with it. The same thing when ... after I picked ... after I ... I met my neighbor. There were some other hunters in there. Dr. C: Yeah. John: And I had told them where to go hunting at. Dr. C: Yeah. John: The first time they'd been in there. And that guy, he does the same thing. He says, man, I'm glad you're all right…He says, you look ... you look like something got you (Barbara laughing). The same thing. And ... and I don't generally cry in front of....men. I'm not ashamed..... Dr. C: I didn't hear what he said. You look? John: You look scared, and like you saw something, you know. So any ... anyway, he ... he was ... was very nice. He says, I'm glad you're all right. Dr. C: Uh-huh. Yeah. John: And..... Dr. C: He was trying to calm you, but..... John: He was. I ... I think it was comforting that a couple people in the store that I know quite well, they … Dr. C: Yeah, they were concerned and supported you? John: Yeah, they came over and talked to me. Dr. C: What was the second guy's reaction? John: He ... he was just ...he was happy that I didn't ...that I was not mauled by ... by the ... that bear..... Dr. C: Right John: You know. So, and wished me well, so ... and then after I went back to where we were staying, a pastor came over. He was a pastor from Georgia, up there on a hunt. Dr. C: Oh, really? John: And he came over and we talked a while, and, you know, it just kind of..... Dr. C: Do you remember what he had to say to you, because that was pretty good (The immediate emotional support provided by all others provided an opportunity to get immediate stress debriefing This likely played a role Combat Memories and survivor Guilt 71

in facilitating his rapid recovery.) you ...you almost needed a pastor if it had turned out differently! What did he say? John: Oh, I don't know. We ... we … I guessWe just talked about ... about life in general, and how things happen, and... and… how that ... that, you know, “Somebody was looking out for me.” The “Old Man Upstairs” as well..... Dr. C: Yeah. John: You know. He ... and He was... “Somebody” was! Barbara: Well, he ... he also said there's always a reason for everything..... Dr. C: And..... John: Yeah. Barbara: And “Although you may not understand it” (Pastor's philosophy) Dr. C: And do you have a faith in a higher power and all that? John: I do. Dr. C: Well, what..... John: And… and..... Dr. C: What is it? John: Also I have ... I have faith in me as well. Dr. C: Yes. John: I con ... I consider myself as good a man as there is in the woods. Dr. C: Well, I think if I were out in the woods and bear was coming my way, I'd like to have you around. John: So ...but there again that's ... it just it struck me the wrong way I guess. My end words to that would be it was way, way, way too close for comfort. Dr. C: Uh-huh. John: Had it been the one bear, I would have probably been okay. But when I turned and there's three of them, then that just ... that was too much! Dr. C: I'll tell you, a lot of folks that are either listening or reading this, I think one bear would pretty much for them! John: Yeah. Dr. C: So it's your depth of experience that helped you through this in a way? John: I ... I think so. And probably one of the other things that bother me with is ... is through this is that I guess I feel that my age caught up with me as well. You know, that I ... I don't think that would have happened to me, could have be it, I don't know, years ago. I think I ...I don't think I'm as sharp as I used to be, and so I've got to be a little more cautious now that I'm older, pay a little more attention. Dr. C: Yeah. So you're aware that you're not what you used to be, and ... and that's a problem for all of us when we get older. John: Exactly. Dr. C: And we don't like to face that, right? John: Correct. Dr. C: At least you're man enough to admit that, and that's a form of maturity. Okay. Well, now, what about that night when you went to sleep? What was it like trying to go to sleep? John: I had a horrible time trying to go to sleep. Dr. C: What was going through your mind? John: Just ... I just kept seeing those bears, just ... just constantly seeing those bears all the time. And then I'd lay there and I would think, what if, you know. What if she had knocked me down, would all three of them have eaten me? Just ... just goofy things, you know. Dr. C: Okay. Those images coming of the three bears, describe them? What were they like? John: I just remember her doing that. And I just, you know, the..... Dr. C: With the ... the mouth business... John: Yep. I..... Dr. C: and the sound. What was the sound? 72 Cassell et.al.

John: Just a click, click, click, click from the teeth. (Be informed that he loudly mimicked the highly threatening sound!) Dr. C: Oh, yeah. John: And ... and not just ... I guess a couple times I thought, she's biting me, you know? (Under extreme psychological stress, sensory reality testing in a psychotic fashion may be transiently distorted. Sometimes, even for years later, such distorted imagery can shape and emotionally color both PTSD “Nightmares and daytime “Flashbacks”. Clinically they may be brought into full awareness for cognitive correction/emotional reprocessing during therapeutic SIS sessions.) Dr. C: Yeah. John: With her ... the mouth thing. Dr. C: Yeah. John: And in ... and in..... Dr. C: Did you feel pain? John: No, I didn't ... didn't feel any pain. Dr. C: Uh-huh. John: I was scared still. Dr. C: Oh, yeah. So this went on and eventually you did sleep? John: Eventually I went to sleep, yes. Barbara: May I comment? Dr. C: Okay. And then the next thing we want to hear is from you, Barbara, because your hunting hero who thankfully survived, had a dream episode in the bed when he was sleeping? Barbara: Well, first of all, I'm really surprised that when we got up the next day after the incident that we actually went across the river. I really thought after that experience that he might be inclined to not want to go back in the woods, so I have to pat him on the back for his bravery and going back in. Dr. C: Well, I have to shake your hand John, because there's a lot of ... written in the phenomenological PTSD literature… that when someone significantly suffers from a stressful event, the next thing ... “The best thing the victim can do is get on the horse and ride it”, or face it as you did. If one procrastinates, that's when the individual may start to build up phobic reactions and other lingering PTSD symptoms from the stressor. Anyway, let's hear some more. Barbara: So we went in and we were successful the first night in, and we ... we got a moose, and we stayed..... Dr. C: Oh, you did get a moose? Barbara: Yeah. We stayed a few more days, because it takes, you know, a good day to get the moose hung up. And then, you know, we … we still had more tags to fill out and so we hunted some more to see if we could get a second one, and ... and we weren't successful. The ... the scary part about it, after what had happened to him, the game trails around where we were camping were just covered with bear tracks. Dr. C: Oh, yeah? Barbara: And, I mean, at one point I started even ... you know, because you're just … your … your senses are on high here, that I started looking behind me as I'm walking down the trail and ran smack dab into a tree. And I said, this is ridiculous. Get a grip on yourself. (Anxiety is psychologically “infectious”. Sometimes it can distort perception for others who are highly psychologically suggestive, in learningabout a PTSD victim's traumatic experience.) Dr. C: So you had quite a bit of anxiety subsequently, too? Barbara: I did… I did… You know, you're in a tent, you're in the woods. There's bears around you. After that, it … it makes you on high alert. Dr. C: So did you have any vision of bears? Barbara: No, I just was..... Dr. C: Or dreams of bears? Barbara: No, I was just really.... More concerned than in the past, because we've been hunting.....Up there forever, you know, and we've never had an encounter. We've seen bears, but they're usually going the other way. Combat Memories and survivor Guilt 73

Dr. C: What about you John, did you have a dream of that bear down the road or..... John: I've never had a dream about the bear…Except that first night, about it. Dr. C: So was it a dream or a vision? John: No, that was a vision. (A replication of a stressful scene in full conscious awareness.) Dr. C: Okay. John: I never ... never did have a dream about it. (From a theoretical standpoint it is important to note his apparent total amnesia for PTSD dreams depicting the highly stressful near death hunting encounter with three bears.) Dr. C: Okay. But you said that you did have some dreams. Tell..... John: Correct. Dr. C: Tell me about some of the nightmares you had. Barbara: So then later when we got home, and, you know, he was still very upset. This is about eight to ten days later, and..... Dr. C: So after a major stress, facing death, it goes on, and this was eight days later, and you're still on high anxiety, and..... Barbara: Yeah. Dr. C: What was he like? Barbara: He was pretty wound up. Dr. C: No doubt! Barbara: And, you know, he wasn't sleeping well. He was tossing. You ... you had gotten up a couple of different times. And so at one point ... I mean, he's always been a sleep talker. I mean, we …we all know that… He's always talked in his sleep, but normal..... Dr. C: (Joking) Sometime I might tell you what he said in his sleep when I was hunting with him... (Laughter from Barbara and John) But we're friends. No, I'm kidding! (Sometimes appropriate humor canreduce tension in a stressful PTSD interview.) Barbara: So the ... the one night I'm ... I'm lying there and he's uttering bluh-bluh-bluh-bluh-bluh, and …you know, and you can't … it's pretty incoherent, you can't hear it. But then I kind of woke up, and ... and then he goes, “Thunder Eagle, Thunder Eagle, or we're ...we're going down! May -- or, now, he goes, May Day! May Day! May Day! Thunder Eagle! Thunder Eagle! Whatever the number ... call signs are... We're in autorotation! We're going down!” And I'm like, what is that? You know, he's … he's a Vietnam vet. He never has spoken hardly ever about Vietnam. I was like, WOW! Dr. C: So this is the first that you heard PTSD stream of Vietnam memories? We're down the road with quite a number of years. John do you recall that dream? John: No. (Dr. C. I have had extensive experience in the clinical care of PTSD victims, but not in interviewing their listening bed partners. Here it is remarkable that he is amnesic to the anxiety charged dream and the sensory feedback of its psycho-physiological arousal.) John: No. Barbara: So it's ...it's happened that I know of ... I mean, because he talks so much in his sleep that most of the time I tell him, Shut Up! Dr. C: Okay. So he was having quite a bit of conversations in his sleep, and..... Dr. C: But John you don't recall having a lot of flashbacks of Vietnam or? John: Just a few, not ... not so many. Th... that autorotation, because we've done two of them, two different times. That's probably the only two that ever comes back to me, because that was … that was one of these are you going to ... you ...you do or don't. You know, in autorotation, you either make it or you don't. John: You know what I mean by that, don't you? Dr. C: Can you clarify it? John: I was a crew chief on a helicopter. Dr. C: Uh-huh. John: A Hughie helicopter. And you … and if you're going to crash because of loss of power and stuff, and the 74 Cassell et.al.

rotor's turning, or the tail rotor's out, and this, that.... Dr. C: Right. John: and the other and you're shot up. They … they turn the pitch on the props, and it slows it down, and you're … you're coming in and doing an autorotation. Dr. C: Right. John: Either under power or out of power. And… and its real fast hit the ground, and the ... the rotor don't fall right or left, and you hope it don't go forward, because it goes right down through the cabin if you hit real hard nose first. So they kind of slide it in there, and you bring it down. It's ... it's built to do that. Dr. C: So a brush with death you had? (Two Actually!) John: Well, yeah. Exactly. Dr. C: Yeah. John: Let alone these bullets flying at you at night when you're flying and all that kind of stuff. Dr. C: Right. John: We flew a lot of military brass back and forth from different areas, and we were always getting shot at… at night. We didn't run lights on the helicopter, but they could hear it, and they'd just shoot. It's ... you know they're shooting at you because we ... you could see the tracers coming up in the air, so..... Dr. C: Do you have any residual of that that troubles you more than anything else or ... in the daytime or..... John: You know, really the only time I've ever I don't think I let it get to me, but I've watched a lot of Vietnam movies with different characters and stuff, and it does bring it back, and then recent I think of people that I knew that were lost and things like that, but..... Dr. C: And what do you feel when you think of some of your buddies that didn't make it back? Dr. C. What's the sadness like? John: I guess I asked myself a number of times just why wasn't it me. You know, why I -- why did I come home and why did they not come home. Things like that. Dr. C: Yeah. John: You know… And... Dr. C: It makes you feel sad for sure. John: Oh, sure. Yeah. Dr. C: Yeah. John: And, I mean I was … I was single. Some of the guys I knew, they had families. Dr. C: Uh-huh. John: I felt very, very sorry for them, that their wife and their children would never see them again. You know those kinds of things. So... Dr. C: Your husband has got love in his heart for people. You're a good man. Responding to the SIS-II Stamp Version: Dr. C. Could I ask you on this, John, do any of those pictures remind you of the bear attack in any way? Or brought back any of the feelings you might have had in your body or else? John: I … I only see one that … that struck me a little tiny bit but not much. Dr. C: Let's look at it. And that look like what? John: It looks like a skeleton. Dr. C: The rib cage? John: Yes. Dr. C: And when you look at that rib cage what emotions do you feel? John: Those guys that didn't come home that they found years later and are still looking for. Dr. C: Your heart's still heavy. You … did you do a lot of grieving at the time, or did you hold that grief inside. John: Probably held it inside. Dr. C: Yeah. John: I'm not one to show too much. I always tried to be the strong one.....the big guy, you know, so..... Combat Memories and survivor Guilt 75

Dr. C: Yeah. John: I can … I'm one that can go and in it alone and do it myself. And that's why I think … I think that's what means some of the most to me is where we hunt up … up there, going up in the mountains and sitting up there. I wouldn't call myself a perfect Christian, but I can up in the mountains and sit there and say, God, you made a beautiful world…Thanks! Dr. C: Uh-huh. John: Thanks for … for what you gave us, you know, and help me to be a better person than what I am. Dr. C: Uh-huh. John: So..... Dr. C: And that makes for healing, doesn't it? John: Well, I think so. Dr. C: Yeah. John: Absolutely. Dr. C: Would you like to comment on any more of this, Barbara? Barbara: I agree that when he does watch any of those war movies..... Dr. C: You must feel quite proud of your husband and his courage, don't you? Barbara: I do. I feel really proud of him. But I think he does hold things a little bit too tightsometimes. Dr. C: Part of being male. Barbara: You know, I … I know that when he does watch those military..... Dr. C: Yeah. Barbara:...movies that he has some rough days afterwards. Dr. C: Yeah. Barbara: He doesn't do it very often, but, you know, I was going to recall that the first time when we first moved up here and we went and saw Rambo, I'm … we had just moved up here, and he had a couple of bad days, and I was like going, what are we doing here? Dr. C: Yeah. Yeah. Barbara: So far from family, and … but we've got our own family up here now. Dr. C: Do you maintain touch with any of your buddies and that? John: Only … only one or two, but I haven't in the last twenty years or so. Dr. C: Yeah. But the fact that it … the bear brought that material out, what does that tell you? John: Must still be there. Dr. C: With time we heal some. That's why we have dreams, you know. We have these dreams of recurring stressful events, but they occur during the relaxed state of sleep now. That's how you start out.But as the image persists, and … and we're talking seconds, then your whole autonomic nervous system gets aroused and all that, but in a way each time that occurs, it sort of neutralizes just a bit. And so …and that's nature's healing. But there are some psychological techniques for vets that help with this, and it's one of the things that has been gratifying tome. I've done some work in developing those, with inkblots and … and not in the state of sleep, but presenting relaxing scenes and flowers. Don't you think this is one reason that Alaska's a great place for veterans who have had trauma, because of the natural beauty and isolation, just as you do? You've been able to partially heal through experiencing Alaska's Natural beauty. John: Oh, absolutely. Dr. C: Could you comment on that? John: Probably there's no doubt. I was born and raised in the south.....and I wouldn't trade Alaska for all of the south. It's the...mountains, love them just have … just have so much to offer. Dr. C: Supposing there's some veteran out there who's been traumatized psychologically and … and what would you advise them in terms of nature or coming to Alaska or whatever? John: Well, myself, I've thought of that just a number of times in my life, especially since my children has left home, that … that I would … it's just … it's just kind of 76 Cassell et.al.

thinking when you're sitting here doing, you know your own little thing, that I wouldn't mind sponsoring a guy that's a war veteran that's been wounded or something, maybe try to take him hunting or take him fishing, someone from Outside.... who could experience in Alaska (indiscernible) the way… the way we have. Barbara: We already did one of those trips this fall. John: Yeah, we did with one who is in currently in the military, and the guy had a wonderful time. You know, it's my neighbor's son, and … and....I would … I would do it again. Dr. C: Well, I think that's.....a wonderful thing to help suffers of PTSD, and maybe we could make that known if this is published and actually make that available, because my philosophy is what … when we give, we receive, and many of us, as you know, therapist type are … we get something out of being a therapist and helping people. John: I … I think that would be good for me to experience that with someone. Dr. C: I think so, too, and that's a fundamental underlying principle in Alcoholics Anonymous, that is … the guy make … gets into sobriety and has a mentor, and then eventually becomes a mentor, and again in giving, receives. And the notion of the higher power is important! I don't see how people can get through life without some sense of a higher power or spirituality. What do you think about that? John: Hmm. I don't really know how to answer that. Dr. C: It's a … it's a big philosophical question. It's something to think about. Do you … would you like to say anything more before we terminate? Barbara: Well, I … my father just passed away in November. Dr. C: Oh, I'm sorry. I didn't know that. Barbara: And -- and..... Dr. C: You're grieving then. Barbara: Well, I guess that … but he was in hospice care for about three and a half weeks before he perished. Dr. C: Yeah. Barbara: And his … his faith is … it carried him right to the end. Dr. C: Yes. Barbara: And if he hadn't had that, it would be a much more traumatic experience. Dr. C: Yeah. Well, my heart goes out to you, too. But it is true. I don't know how the atheists deal with loss, and … but… anyway. Thank you both. John: I think if … if I had only one thing to say about all of this, knowing me the way I felt I knew me, I'd love to know to myself what part of this … what part of this really made me cry, because nothing's ever done that to me. I … I've shed some tears when my children graduated from high school and fromcollege, and when they had their children, because it was a happy cry, you know. But I would … I would give anything to know why I done that. I guess just I must have been too wound up. Dr. C: Tears are in many forms, but I think crying gave you relief. But I think that's a subject for us talking again, and we can do that. We will do it! Discussion: This article exposes in a phenomenological descriptive fashion, certain methodologically illusive dark aspects of DEATH IMAGERY. Since readers of this journal are primarily concerned with applications of the SIS, the discussion will begin with the symbolic DEATH response projected onto the color-form structure of the “STAMP” SIS-II inkblot. It may be recalled that it triggered long term combat memories of finding decayed skeletal remains of deceased comrades in the remote Asian jungle. This projective scene was linked with long standing unexpressed grief linked with irrational “SURIVOR'S GUILT” He felt guilty that he had survived yet many of his combat friends had died! On the basis of SIS case history studies such as this, it would appear that military and police organizations worldwide near to place more emphasis on debriefing professional victims immediately after such severe occupational stress. Such irrational “GUILT” almost involuntarily shapes Combat Memories and survivor Guilt 77

such a military or law enforcement survivor's thinking, when a tragic event happens to a close colleague on duty: “Was his/her death somehow my fault? Could I have prevented it etc.? Such sadness can color emotionally and shape guilt ridden dreams of grief. A similar, transient weakening of his cognitive reality testing for his body's somatic sensations, was subjectively experienced during the near death bear attack. Fortunately expertise with high powered rifles, as well as his mental skeletal muscle reflex like quick response saved his life. Yet the resonating anxiety charged memories of anxiety charged visions in combination with sensory feedback of autonomic nervous system excitation (e.g. increased heart rate, rapid breathing etc.) altered his Body Awareness. It stimulated a transient psychotic like faulty perceptions of haven been bitten by the bear. As his nervous system arousal subsided, so did the somatic delusions. What persisted into the evening in bed when he shut his eyes was the involuntary intrusion of affect charged death visual imagery recapitulating the event. In spite of their persistence for a few days the following history is conceptually noteworthy: in all the immediate subsequent mornings after the bear attack, he denied that the “Day Residual” from these “Flashbacks” or “Visions” previously experienced in bed prior to sleep, ever subsequently stimulated traumatic bear dreams. (Such memory inhibition is quite inconsistent with the findings of dream researchers who purposely waken a sleeper after a stressful event to study thecontent.) Yet for such anxiety linked bear imagery he was totally amnesic. Consequently it is hypothesize that such visual image amnesia reflected an out conscious control involuntary mental defense mechanism. The authors choose to label this inhibitory process as “Cortical-reflex Denial”. The same central nervous system inhibition likely was operating when he denied dreaming of the helicopter crash- even though his wife heard him in a panic stricken dream repeatedly vocalizing “MAY DAY!” From a conceptual standpoint, it is also tempting to similarly speculate about the underlying psychophysiological mental mechanism of his SIS symbolic response. This is speculation is based upon the assumption the projective probing power of the SIS taps into the same source of affect charged long term memory neural based records as PTSD dreams. Given this thesis, the one might postulate that his involuntary mental defense mechanisms permitted the release of anatomical imagery related to the demise of others, not his own body. Perhaps like most humans, to confront one's own death in sleep, or in projected SIS evoked imagery would be too threatening. This thesis is consistent with views expressed by Ernest Becker, cited in his 1973 Pulitzer Prize winning book entitled “DENIAL of DEATH”. It is also based upon theoretical concepts on “Somatic Repression” and Death Anxiety formulated by Wilfred A. Cassell in the 1980 manual for SIS-I entitled “BODY SYMBOLISM”. More recently it conceptually resonates with those expressed in a 2013 book by AjitVarki& Danny Brower “DENIAL Self Deception, False Beliefs and the Origin of the Human Mind”. Thelater authors speculated that the worldwide psychologically defensive tendency for humans to deny reality represents an overall positive development for stress survival based upon a genetic mutation. Relevant Reading: Mathew Tull, PhD presented an internet article April 16, 2014 on “About.com” summarizing the American data relative to Rates of PTSD in Vietnam Veterans. His source was The National Vietnam Veterans Readjustment Study originally conducted by the U.S. government following a congressional mandate in 1983 to better understand the psychological effect of being in the Vietnam War. Approximately 15% of the men and (% of the women were found to be suffering from PTSD at the time of the survey. By comparison, these rates were much higher than observed in non-Vietnam veterans and civilians. Moreover, approximately 30% of the men and 27% of the women had suffered from PTSD at some stage in their life after such combat. Tull concluded that “”The rates are alarming since they indicate that at the time of the study, there were about 479,000 cases of PTSD and an estimated one million life time cases”. There are several psychological forms of treatment for PTSD. In fact, there are so many different conceptual therapeutic models that it may be inferred that there exists no “gold standard” approach. The list includes the following: Cognitive-behavioral Therapy, Exposure Therapy, Stress Inoculation Training, Eye Movement 78 Cassell et.al.

Desensitization and Reprocessing Therapy. In this SIS study the veteran was functioning relatively well. Thankfully, his having spent considerable time in beautiful outdoor Alaskan settings having healing environmental Imagery from “Mother Nature” had reconditioned his traumatic war memories. Apparently as a result his original PTSD symptoms that he had experienced for a few years after Vietnam had largely faded away. Yet his long dormant PTSD “Nightmares” of being severely stressed by two helicopter crashes were briefly reactivated by the life threatening bear attack. Finally in regard to formulating a hypothetical spiritual supplemental therapy program for such a victim of Combat PTSD, enriching this important dimension of his inner religious world could provide an adjunct to the above mentioned psychological therapies. The religious dogma of most major world religions devote considerable cognitive structure enabling aa faith based “Spiritual Guide” to counsel combat victims suffering from “Survivor's Guilt”. For example, Since he is a Christian, than he might be advised to recall that members of this religion project onto personified their image of “GOD” as being loving and forgiving etc. A similar guilt undermining strategy might be used by practitioners of other religions consistent with their own healing religious symbols and philosophy. It is of theoretical interest that he was totally amnesic so only his wife could report the bear trauma induced PTSD dreaming “MAY DAY MAY DAY WE ARE GOING DOWN!” Immediately after Vietnam he often would wake up at night in a extreme psychophysical arousal. Originally when awakening throughout the initial postwar time period, he was fully cognizant of the helicopter crashing dreams. However eventually, this concrete content was slowly replaced with more affect neutral defensive dream symbols. From a theoretical point of view, this symbolic replacement was involuntary secondary to Nature's sleep “Exposure- Stress Inoculation” homeostatic restoring “Therapy”. However sometimes after a stressful day he still appeared to suffer occasional “Nightmares”, such as triggered by the stressful bear attack. However remained totally amnesic to the affect charged PTSD helicopter dream content. His wife heard him mumbling in his sleep provided credence to the above conceptual model. SIS projective techniques may be used both as an adjunct to existing therapies such as in this educational illustration and to provide potentially therapeutically potent new dimensions. While this veteran had not requested treatment, it is apparent that the Booklet form of SIS-II brought out some long standing irrational feelings of a “SURVIVOR'S GUILT”. The “Inkblot' that he rated as most disturbing reflected his grief and guilt at the death of his married combat friends (While I survived!”). If he ever requested SIS supplemented Cognitive-Behavioral Therapy, such inner world suffering could be therapeutically resolved. Finally, it might be recalled that certain of the electronic more advanced forms of the SIS utilize selfadministered Video or Computer technology with relaxing audio suggestions and a model subject verbalizing responding to an illustrative “Inkblot“, Next in privacy, without the potential inhibitory presence of the test administer, the responder records responses on an outlined SIS Answer sheet. The visual presentation of beautiful flowers recapitulates “Healing Alaskan Nature” thereby incorporating theoretical dimensions underlying both “Exposure Therapy” and “Stress Inoculation Training”. In future planning, new SIS visual form-colormovement designs specifically structured to recapitulate ina suggestive fashion combat scenes may in clinical research trials be presented in a case custom made form of a “SIS Artificial Intelligence Machine”. This may eventually provide a technological foundation for providing a PTSD dream dissolving function. Conceivably such SIS evolving technology might providing healing “Day Residual Input” at bedtime for more effectively countering concrete reality memories of stress scene with Nature's neutralizing healing dream symbols. Combat Memories and survivor Guilt 79

References: Amos, Gitaï and the Yom Kippur War.The survivor'sguilt. Delaporte, Sophie ; Revue Francophone du Stress et du Trauma, Vol 9(2), May, 2009. pp. 117-124. Becker, E. The Denial of Death, The Free Press, New York, 866 Third Avenue, New York, New York 10022 Falk, A. (1982). The Role of Guilt Feelings in war Neurosis. Clinical and Community Psychology: Stress and Anxiety, 8, 163-169\ Gilmartin, Robin M. Southwick, Steven; Combat Related PTSD and Logotherapy.International Forum for Logotherapy, Vol 27(1), Spr, 2004. pp. 34-38. Glover, Hillel (1984). Survival Guilt and the Vietnam Veteran. The Journal of Nervous and Mental Disease, 172 Kubany, S. Edward, (1997) Application of Cognitive Therapy for Trauma –Related Guilt (CT-TRG) With a Vietnam Veteran Troubled by Multiple Sources of Guilt. Cognitive and behavioral practice 4, 213-244. Opp, E. Roy, & Samson, Y. Anne (1989). Taxonomy of Guilt For Combat Veterans. Professional Psychology: Research and Practice, 20, 159-165 Varki, A., & Brower, D (2013). Denial: self-deception, false beliefs, and the origins of the human mind. New York: Twelve. Wilson, P. John, Drozdek, Boris, &Turkovic, Silvana, (2006).Posttraumatic Shame and Guilt.Trauma Violence Abuse 80 Cassell et.al.

Gender-Specific Personality Differentials of Suicide Ideation among Adolescents Umed Singh and Kamlesh Rani The present study aimed at the exploration of gender-specific projective and psychometric personality indicants of suicide ideation. For this, 300 Senior Secondary School students (150 females & 150 males) randomly drawn from various schools of Gurgaon and Delhi, were administered with Beck Scale for Suicide Ideation, SIS-II and Neo-FFI. The obtained data were analyzed by Descriptive Statistics, t-ratios, Pearson's Correlations, and Principal Component Factor Analysis. The t-ratios revealed female students to score significantly high on Suicide Ideation, Human, Animal, Movement, Most Typical, Neuroticism, and low on Anatomy, Extraversion, and Conscientiousness. Correlations and Factor Analysis depicted structured overlap between suicide ideation and personality variables. Neuroticism, Extraversion, Movement, Depression, and Hostility & Aggression have emerged as most common correlates of suicide ideation in male and female students. It suggests Personality-Suicide-Constellation Index consisting of N+, E-, M+, D+ and HAS+. The findings further suggest the need of large scale investigation of personality correlates of suicide on both suicide ideation and attempt. Suicide is accounted for as one of the most fundamental health problems throughout the world and approximately 900,000 individuals die of suicide worldwide (Patel et al., 2012). Suicide involves cognitive, emotional, and behavioral components with specific risk factors that may have different characteristics and influences according to developmental age and gender (Min et al., 2012). Suicide worldwide is estimated to represent 1.8% of the total global burden of diseases in 1998 and 2.4% in countries with market and former socialist economies in 2020(WHO 2011). In India, 113,914 people committed suicide in the year 2005 (National Crime Records Bureau 2008). It has been found that more than one lakh lives are lost every year due to suicide in India (Vijaykumar 2010). Suicide is among the top three causes of death among youth across the globe. (Rajne&Chittaranjan, 2012). In India majority of suicides (37.8%) are by those below the age of 30 years and 71% of suicide in India are by people below the age of 44 years. It imposed a huge social, emotional and economic burden on society (NCRB, 2008). Suicidal behaviors include a spectrum of behavior ranging from precursor behavior such as suicide ideation, suicide plan and suicide attempt to completed suicide. Suicide ideation is defined as thinking of engaging in suicide-related behavior and it varies in severity from passive thinking of death and that “life is not worth living” to having suicidal thoughts associated with intent or plan whereas suicide attempt is “selfinflicted behavior” intended to result in death (Abel et al., 2012). Researchers report that adolescents are at greatest risk for suicide ideation and early onset of suicide ideation links with a greater risk of suicide plan and attempt, and that the transition from ideation to plan and attempt occurs within the first year of onset (Bridge et al., 2006; Nock et al., 2008; Abel et al., 2012). Consequently, adolescent suicide has been realized as one of the major health problems recently and now it ranks among the top five causes of death among adolescents, along with unintentional injuries, violence, HIV/AIDs and other communicable diseases. Analyses of trends in adolescent suicide depict that the rate is increasing across the world over the last quarter century in different countries (Patton et al., 2009; Wasserman et al., 2005) including India (Radhakrishanan& Andrade 2012). The risk of suicide increases as individual progresses from having passive thoughts of self-harm to having a suicide plan (Gibb et al., 2006; May et al., 2012). Young people perceive suicide differently from adults and the extent to which they perceive suicide as an acceptable alternative increases the probability of considering suicide (Palmier, 2011). Furthermore, adolescents with multiple problems are more likely to engage in suicidal acts (Nock et al., 2008). Hence, suicide ideation Nadine J. Kaslow, Ph.D., Professor and Kamlesh Rani, Research Scholar, Dept. of Psychology, Kurukshetra University, Kurukshetra, E-mail : umed.psy@gmail.com Key Words: Suicide Ideation, gender-specific, personality, adolescents.

becomes an important marker for future distress and deficits in psychological and behavioral functioning, therefore, an understanding of risk factors which may predispose an individual to suicidal thoughts, is important for a successful preventive approach. The identification of suicide ideation may help health professionals to provide preemptive interventions to those at risk and to lower the suicide rate. This preventive approach is even more crucial because family members are less likely to recognize suicidal teens (Miller & Eckert, 2009). The risk factors related to suicide ideation in youth are multifaceted and include mental problems, personal and family characteristics, adverse life events, problem behaviors and friends (Gould et al., 2003; Nock et al., 2008; Abel et al., 2012; Park, 2013). Literature also reveals that traditional research on risk factors of suicide ideation has mainly focused on either demographic markers or psychopathological variables; and to some extent overlooked the personality dispositions/traits (Turecki 2005; Dogra et al., 2008; Stewart et al., 2008; May et al., 2012; and Soltaninejad et al., 2013). Personality traits have several properties that make them attractive targets for suicide research and intervention. First, personality traits affect the variables that may contribute to the diathesis for suicide and self (Dean et al., 1996). Second, their maturational patterns may render them more suitable for long term public health interventions in comparison to other more modifiable risk factors i.e. even though traits are amenable to modification only relatively early in life, so any intervention carried out at that time would have longerlasting effects (Roberts and Delvecchio, 2000). Thirdly, personality may be useful in early identification of subgroups of suicidal individuals, such as attempters (Larget et al., 2006) and completers (Useda et al., 2007). Fourth, gender-specific personality differences may contribute in the understanding of gender similarities in suicide ideation, attempts, and completions (Widiger and Anderson (2003). Fifth, personality traits, that are partly genetically determined, may be endo-phenotypes for genetic component of suicidal behaviour (Baud, 2005; Turecki, 2005; Brezo et al., 2008). Personality traits commonly found as predisposing factors in suicidal behaviors (included attempts, completed, and ideation) in researches are hopelessness, neuroticism, extraversion, aggression, anger, impulsivity, and perfectionism (Brezo& Tremblay 2006; Brezo et al., 2006; 2008; Stewart et al., 2008; Giegling et al., 2009; Soltaninejad et al., 2013). Majority of the studies in this regard have attempted to identify psychometric personality correlates of suicide ideation by using personality questionnaires which suffer from various limitations such as faking, social desirability, response set etc. (Cattell, 1957; Cattell& Warburton, 1967 ; Cattell& Dreger,1977). Genesis of suicide ideation may also be buried into unconscious, so it is more essential to explore the unconscious indicants of suicide ideation using projective techniques. Based on the contents, projective assessment includes Inkblot Tests, Picture Story Tests (TAT), Word Association Tests, Sentence Completion Tests, Drawing Tests etc. Inkblot techniques have contributed a lot in personality assessment, clinical assessment, and therapeutic intervention. There are three standardized inkblot tests – Rorschach Inkblot Test (RIT), Holtzman Inkblot Technique (HIT), and Somatic Inkblot Series (SIS). Some attempts have been made for exploration of suicide risk by using Rorschach Inkblot Test (Exner, 1993; Fowler et al., 2001; Blasczyk-Schiep et al., 2011) based on Suicide-Constellation Index (S- Con) by Exner (1993) in his comprehensive system. The S-Con consists of four indicators of suicide (MOR>0, FV + VF + V > 0, color shading > 0, and FC < CF + C) and added two more indicators later on (M - >1, and weighted special score > 9). With Holtzman Inkblot Technique, no serious research efforts have been made to explore such suicide – constellation index. With SIS (SIS-I, II & Video) some attempts have been made to study suicide risk factors by Bellamy (1995), Cassell, (2005), Cassell & Dubey (2007, 2010), Dogra et al., (2008, 2011), and Daine et al. (2010), but in most of these studies image sensitivities of suicide ideation have been explored using case study method. No such attempt has been made to establish SIS-Suicide - Constellation Index. The present study is an empirical endevour to explore gender-specific projective and psychometric personality indicants of suicide ideation using multivariate methodology. 82 Singh & Rani

Method: Sample: The sample comprised of 300 School students (150 females and 150 males) randomly drawn from 11th and 12th standard of various Senior Secondary Schools of Delhi and Gurgaon in the age range of 15 to 18 years with the mean age of 16.5 years.. The sample also did not include the students having history of suicide attempts. Measures: (i) SIS-II Booklet Form (Cassell, 1990, Cassell and Dubey, 2003), was developed in 1990. It consists of 62 images, 31 each in series A and B. The test can be used as an individual as well as group test. (ii) Neo-Five Factor Inventory (Neo-FFI; Short Version) is based on five factor model of personality. Costa & McCrae (1992) developed Neo–FFI to index five personality dimensions – neuroticism, extraversion, openness, agreeableness, and conscientiousness. Costa & McCrae (1989) selected 12 items for each scale from original NEO-PI (180 items) to develop a short version called Neo-Five Factor Inventory (Neo-FFI) consisting of 60 items.. The Neo-FFI has been used in the present study to index the five factors of personality. The five scales of Neo-FFI have been assessed for internal consistencies and test-retest reliabilities. The alpha coefficients for individual facet-scales ranged from .56 to .81. The full scale coefficient alphas ranged from .86 to .95. The test-retest reliabilities (with 3 months interval) of Neo-FFI scales obtained from college samples have been found to be .79, .79, .80, .75 and .83 for N, E, O, A, and C respectively. Hence, it is considered to be a reliable and valid measure of five factors of personality across the world. (iii) Beck Scale for Suicide Ideation (BSS; Beck, Steer, and Ranieri, 1988) is a 21 item self-report instrument that measures the severity of suicidal ideation in adults and adolescents. BSS measures a broad spectrum of attitudes and behaviors that are best considered as indicators of suicide risk rather than as predictors of eventual suicide. Out of 21 items, the first five BSS items serve as a screen for suicide ideation. If a respondent circles the statements as zero in both Item 4 (indicating no suicide intention) and Item 5 (indicating avoidance of death if presented with a life threatening situation), then he or she is instructed to skip to the next 14 items which relate to specific information about the respondents' plans and attitudes. Any respondent who has previously attempted suicide is requested to rate Item No.21. The severity of suicide ideation is calculated by summing the ratings for first 19 items (items 20 & 21 are not included in the score). The total BSS score can range from 0 to 38. Statistical Analysis: In the first instance, the mean scores on suicide ideation scales were used to ascertain whether male and female students differ significantly in terms of suicide ideation or not. Thereafter data were computer- processed for computation of Pearson's correlations among all the variables separately for two groups (male and female); and further Principal component Factor Analysis with orthogonal varimax rotation was used to extract factors using eigen value < 1.00 criterion for each group. Results and Discussion: Descriptive Statistics (Mean, SD) and t-ratios were computed to compare the two groups in terms of significance of mean differences in scores of SIS-II; BSS and Neo-FFI variables. Perusal of Table 1 reveals that female students have scored significantly high on SIS-II scales of Human, Animal, and Movement; and significantly low on Pathalogical AnatomyScale than their counterpart males. Here, it is to be mentioned that in case of scales of Rejection (Rej.) Anatomy & Most Typical, the obtained t-ratios are approaching the significance level. The female students have scored higher on Rejection Scale, Most Typical and low on anatomy and rejection. On five factors of personality indexed by Neo-FFI, female students have scored significantly high on neuroticism than their counterpart male students depicting them to be more susceptible to psychological distress and emotional instability. On Beck Scale for suicide ideation, female students have scored significantly higher than male students depicting them to be more susceptible to suicidal thinking in confirmation to findings of earlier studies (Kumar 2004; WHO, 2011; Radhakrishnan and Andrades, 2012). Suicide Ideation 83

84 Singh & Rani Table 1 Comparison of Mean Scores of female and male students on SIS-II, NEO-FFI and BSS Variables Females (N=150) Males (N=150) t Sig. M SD M SD R 60.820 1.832 60.580 2.115 1.050 NS H 19.180 4.503 17.653 4.370 2.979 P<.01 A 10.607 3.527 9.140 2.951 3.906 P<.01 At 10.546 3.590 11.226 4.143 -1.519 NS Sex .973 1.209 1.040 1.379 -.446 NS M 6.906 4.337 5.766 3.973 2.374 P<.05 MT 9.080 2.335 8.600 2.452 1.736 NS T 11.446 3.719 11.526 4.287 -.173 NS AT 2.373 1.811 2.186 1.471 .979 NS Rej 1.153 1.808 1.420 2.115 -1.174 NS PAS .740 1.297 1.080 1.411 -2.172 P<.05 D 4.860 2.951 4.426 2.778 1.309 NS HAS 3.260 2.253 3.586 2.069 -1.307 NS P .946 1.283 0.926 1.147 .142 NS N 26.333 4.342 25.000 4.368 2.651 P<.01 E 25.306 4.420 26.080 4.547 -1.493 NS O 24.453 4.145 23.686 4.375 1.558 NS Ag 25.726 4.886 26.140 4.370 -.772 NS C 27.320 5.450 28.053 5.507 -1.159 NS SI 6.166 4.106 5.094 3.843 2.332 P<.05 Inter-correlations: Pearson's correlation coefficients were obtained among/ between all the 20 variables (14 of SIS-II, 5 of Neo-FFI; 1 of BSS) in the data from both groups (Table 2). Degree of Freedom being 184(N-2) in female students data, correlation coefficients of .13 and .19 are significant at .05 and .01 probability levels respectively, whereas in male students' data (df =292), the coefficients of .12 and .15 have been found to be significant at .05 and .01 levels.

Suicide Ideation 85 Table 2 Correlations between variables of SIS-II, NEO-FFI and BSS S.No. SIS-II Scales BSS (Female) BSS (Male) Total No. of Response (R) .024 -.143 Human Response (H) -.060 -.036 Animal Response (A) -.022 .071 Anatomy Response (At) .036 .058 Sex Response(Sex) .083 .113 Movement Response (M) -.049 -.060 Most Typical Response (MT) -.059 -.212* Typical Response (T) .109 -.021 Atypical Response (AT) .045 -.141 Rejection (Rej) -.023 .143 Pathological Anatomy Scale (PAS) -.064 .056 Depression (D) .580** .484** Hostility & Aggression (HAS) .322** .077 Paranoia (P) -.080 -.060 Neuroticism(N) .561** .356** Extraversion(E) -.071 -.104 Openness(O) -.045 -.104 Agreeableness(Ag) .046 .132 Conscientiousness© .000 -.038 * Significant > p .05, ** Significant > p .01 In female data, four significant correlations were obtained. Suicide ideation correlated significantly with depression (r = .580 p < .01), Hostility & Aggression (r = .323) of SIS II and Neuroticism of Neo – FFI (r = 561 p < .01). In case of male data, Suicide Ideation was found to be negatively correlated with most Typical ( r = -.212 p < .01), and positively with Depression (r = .484), and Neuroticism (r = .356 p < .01); Depression and neuroticism have emerged as the common correlates of suicide ideation across the gender, whereas Most Typical in males emerged as the gender-specific correlate of suicide ideation. Out of context, the inter-correlations among 14 variables of SIS II (Females data) have ranged below .360 and -.990 with 19 of 91 being significant, (15 positive and 4 negative). In case of males, these have ranged from .518 to -.999 with 20 of 91 being significant (15 positive and 5 negative). Significant correlation among some of the scales of SIS-II in both data may be because of their association with some projective personality factors at higher order level. Similarly, intercorrelations among five factors of personality (Neo-FFI) are low in general (Female's data; 4 of 10 being significant and 7 of 10 being significant in male's data) depicting the possibility of existence some higher order factors. Factor Analysis: Obtained correlations among/between all the variables in both data (14 of SIS-II, 5 of Neo-FFI and 1 of BSS) were further analyzed by Principal Component Analysis with eigen values > 1.00. Initially extracted factors (unrotated) were rotated by varimax procedure to yield orthogonal factors using .29 criteria (Herman, 1960).

86 Singh & Rani Factors Female data Factors Male Data I Sui Ideation(+) D(+) N(+) HAS(+) .846 .764 .748 .590 I T(+) At(+) MT(+) Sex(+) H(+) AT(+) .840 .776 .540 .500 .363 .316 II Rejection (-) R(+) A(+) .978 .973 .254 II Reg(-) R(+) A(+) .970 .970 .325 III At(+) T(+) Sex(+) A(-) .753 .719 .598 .403 III C(+) O(+) Ag(+) PAS(-) .775 .738 .592 .290 IV C(+) E(+) Ag(+) .815 .747 .532 IV Sui Ideation (+) D(+) N(+) MT(-) .848 .712 .546 -.274 V P(+) M(+) A(-) Ag(-) .662 .601 .597 -.274 V M(+) AT(-) H(+) Sex(+) MT(+) N(-) .78 .617 .387 .369 .369 -.265 VI H(+) Mt(+) M(+) .752 .721 .372 VI PAS(+) HAS(+) H(-) MT(-) AT(+) .707 .667 .488 .327 .289 VII O(-) At(+) P(-) A(+) .674 .659 .308 .266 VII P(-) E(+) N(+) A(+) .765 .486 .398 .343 Table 3 Factor Loadings for Factor Analyses in to two groups (females and males) data. Obtained varimaxely 8 rotated factors (Females data) have been identified as Suicide Ideation(Factor I), Proper Imaginative capacity (II), Poor Self-Image (III), Alpha factor (IV), Paranoid Ideation (V), Perceptual Maturity (VI), Openness (VII), accounting for 61.563% of total variance. In case of male's data, 7 varimaxely rotated factors accounting for 63.579% of variance, have been identified as Perceptual Maturity (Factor I), Proper Imaginative Capacity (II), Beta factor (III), Suicide Ideation (IV), Psychological Maturity (V), Diseased Anatomy (VI), and Poor Self-Image (VII). Factor I for females and factor IV for male's data are most revealing from the view point of correlates of suicide ideation. These have been interpreted and discussed. Factor-I of female data has been highly loaded on the measure of Suicide Ideation with the loading of .845 followed by Depression, Neuroticism, and Hostility & Aggression with respective loadings of .764, .748 & .590. All the significant loadings are positive, depicting the positive association among the markers and suggest it to be a factor of Suicide Ideation. It has accounted for 11.310% of total variance. The obtained structure descri'bes a person with suicide-ideation characterized by depressed mood, hypochondriatic pre-occupation, hostile attitudes & impulses, aggressive conflicts, emotional instability and negative affect such as fear, sadness, embarrassment, guilt and disgust. Factor IV of male's data has highly loaded on the measure of Suicide Ideation (.848) followed by

Suicide Ideation 87 Depression (.712) and Neuroticism (.546). It is apparently a factor of Suicide Ideation. It has accounted for 9.451% of total variance. The obtained structure posits that a person characterized as emotionally instable, having a general tendency of negative affect, introversion, depressed mood, hypochondriac ideation, hostile attitudes, & aggressive conflicts tends to have high level of suicide ideation. Discussion: The goal of this study was to explore the gender-specific projective and psychometric personality correlates of suicide ideation among Secondary School students. This goal was realized by understanding the projective and psychometric personality differentials of suicidal ideation in male and female students by applying t-ratios and correlational analyses (Pearson's Correlations and Factor Analysis). The present study finds the prevalence of suicide ideation to be higher among female students compared to male students in confirmation to the gender differences documented in previous research findings (Santrock, 2008; Park, 2013; Epstein &Spirito, 2010; Kerr et al., 2008; Min et al., 2012). Gender differences in suicide ideation may be attributed to gender similarities in psychopathology (Beautrais, 2002). Young females are more vulnerable to internalizing disorders such as depression and anxiety disorders which are well known predictors of suicide ideation. Obtained gender differences in suicide ideation in India can also be understood in terms of culture and gender-related differences in the achievement of autonomy in adolescence. Adolescents in India do not seek independence as early as those in Western countries, and males tend to be given more independence than females (Santrock, 2008). The present study makes a unique contribution to the field by investigating both psychometric and projective personality correlates of suicide ideation. Findings of the present study suggest neuroticism and extroversion dimensions of Neo-FFI to be the most potential correlates of suicide ideation. Neuroticism has marked positive association and Extraversion has marked negative association with suicide ideation in both male and female data. The present finding is very much in line with findings of earlier studies (McClure, 2012; Brezo& Tremblay, 2006; Brezo et al., 2006, 2008; Stewart et al., 2008; Abel et al., 2012). For the exploration of projective correlates of suicide ideation, SIS-II was used in the present study. Results have revealed the scales of Depression and Hostility & Aggression to be significant SIS-II correlates of suicide ideation. Studies about SIS- II correlates of suicide ideation are scarce in literature, so the present finding can't be critically discussed. But the positive association of depression and Hostility & Aggression (HAS) with suicide ideation is very much confirmatory to earlier findings (Min et al., 2012; May et al. 2012) which report strong association of suicide ideation with depression, impulsivity, anger, aggression and hostility. The most unique contribution of this study to the field is that it has attempted to develop Personality – Suicide – Constellation Index consisting of Neuroticism +, Extraversion -, Movement +, Depression +, and Hostility – Aggression + (N+, E-, M+, D+, HAS+). Since the present study is exploratory, its findings cannot be considered generalized. For more generalization large scale studies are required on samples of suicide-ideationers and attempters References: Abel, W.D.; Sewell, C., Martin, J.S., Davidson, Y.B. and Fox, K. (2012). Suicide ideation in Jamaican Youth: Sociodemographic prevalence, protective and risk factors. West Indian Medical Journal,16(5), 1-9. Baud, P.(2005) Personality traits as intermediary phenotypes in suicidal behavior: genetic issues. Am J Med Genet , 133:34-42. Beautrais, A. L. (2002). Gender issues in youth suicidal behavior. Emergency Medicine, 14, 35–42. Beck AT, Steer RA, Ranieri WF. Scale for Suicide Ideation: Psychometric properties of a self-report version. Journal of Clinical Psychology. 1988;44(4):499–505. Bellamy, E. N. (1995). Hospitalised Suicidal Patients and the Somatic Video Procedure: A Descriptive Study. SIS Journal of Projective Psychology & Mental Health, 2(1), pp. 85-91. Blasczyk-Schiep, S., Kazen, M., Kuhl, J., & Grygielski, M. (2011). Appraisal of Suicidal Risk among Adolescents and Young Adults through the Rorschach Test. Journal of Personality Assessment, 93:5, 518-526. Brezo, J., Paris, J. &Turecki, G.(2006). Personality Traits as Correlates of Suicidal Ideation, Suicide Attempts, and Suicide Completions: A systematic review. ActaPsychiatrica Scandinavica,113:180-206. Brezo, J., Paris, J., Tremblay, R., et al., (2006). Personality traits as correlates of suicide attempts and suicide ideation in young adults. Psychological Medicine, 36, 191-202. Brezo, J., Paris, J., Vitaro, F., Hebert, M., Tremblay, R. & Turecki, G.

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Transference and Equal Status Transference: A Relational Probe into Sibling Jealousy Nilanjana Sanyal The formats of a society and the flow of life therein are its interpersonal bonds. In relational matrix in life, the possibilities of health and ill health are equally prominent. Healthy relationships are avenues of happiness and well-being; unhealthy relationships invite pathologies in the system. In the current scenario, sibling jealousy, a very common relational bond is found to affect interpersonal context in a major negative direction. Hence, the need to unfurl the dynamics behind it in the line of transferential bonds in life has been felt. In the context, the concept and contribution of “scripts” as early experiential product and the “script imago” have been discussed. The implications of these in transference, counter-transference, equal status transference and narcissistic transference have been drawn to have a relational probe into sibling jealousy. Conclusion hints at the point that health or ill-health fringes in relationship-context are the by-product of quality of early experiences in life that has to be taken care of by parental figures regarding dependent ones. In early December last year, in a very fresh morning, in the professional arrangement of a hospital room, a young lady breathed her last. She had a chaotic psychotic mind and died of alienation, loneliness and starvation. The root of her problem was intense sibling jealousy that cut her transferential bond with each and everybody around. The day was fresh and bright, but we have lost her to the darkness of unlimited depth…. This abridged unfortunate tale of the lady, like many others, has etched a significant query as: Why do people need 'transference' mechanism in life? What roles does a sibling play in stretched interactive span? The issue needs an examination of the relational contents of life in psychoanalytic theoretical wraps. In fact, the presence and the feel of oneself and others in the context are the beginning of human social life, the interactions between and among the members become the initiator of emotional ties in life. The “self” in an interactive situation is the “subject”, the others are “objects” to him. Interpersonal relationships are thus open acknowledgement of others' “objective” existence. Interpersonal bonds are basic safeguards in life, the providing and getting platter, the canvas of emotional thread-design and common action-networks in social life. The spectrum of interpersonal relationships has shades of positivity and enjoyment, shades of negativity and sorrow and sadness. Life thus depicts relational mosaics. Nilanjana Sanyal, Ph.D. Professor and Former Head, Dept. of Psychology, University of Calcutta, 92 A.P.C. Road, Kolkata – 700009 . Email: sanyal_nilanjana2004@rediffmail.com Sibling Jealousy, interpersonal bonds

Key Words: : The self in interpersonal web: With the birth of a child, a subject or a rudimentary self is brought into this world. Her presence is marked by his body-mind subjective system. With growth and development, there arises his awareness regarding himself and his surrounding social-rim. The individual self becomes conscious of his existent personal features and starts developing knowledge regarding the “objective world.” The conscious element of his mind results in ego development; in the process he becomes an experiencer in life, develops anxiety and at the same time, starts tolerating it. One of the mechanisms of anxiety-adaptiveness seems to be interpersonal bonds. Hence the self basically comprises: the old fashioned concept of the ego as an executive mechanism that moderates self-control and affect states and that mediates relations with the outside world, the experienced internal objects; objects and parts of ego bound together by the affects (feelings) appropriate to the child's experiences of those object-relationships. The self then refers to the combination of ego and internal objects in a unique, dynamic relation that comprises the character and gives a sense of personal identity that endures and remains relatively constant overtime. Psychoanalytically this is called “script” formation. The understanding and analysis of transference phenomenon are regarded by psychoanalysts as being at the very center of theirtherapeutic techniques and the concept is widely applied outside psychoanalysis in the attempt to

understand the self-amidst human relationships in general (Sandler et al., 1973). The self in relation with others: “Object relations,” i.e., connecting the subjectivity of the self with the existing others (objects), is an inclusive technical term that spans the intra-psychic and interpersonal dimensions. It refers to the system of interactions and inter-relationships between the various elements of the self, which are then expressed in the arena of current relationships with other people. Internal objects and other parts of the self are reciprocal with outer objects, so that, in any relationships, the personalities are mutually influenced by each other. That is, external relationships are in constant interaction with internal psychic structures. It is an amalgam of the work of Fairbairn, Winnicott and others of the British Independent group, augmented by that of Melanie Klein and the Kleinian group. (Fumihiko et al, 2000).In the general flow of life, during the course of development, children establish complex relationships with key people, particularly parents, which include attachment and the meeting of a variety of needs which change over time. When such needs are not met or where the relationship is broken, the potential is there for the repetition, avoidance or idealization of equivalent subsequent relationships through the phenomenon of “transference”. The concept of script: Transference is created during the early months of an infant's life during the period when it is beginning to create an ego. The baby has no conscious mind then, only has the sub-conscious one. This makes it easy for the baby to attune to the mother's subconscious mind and to her internal conflicts too. One reason for this is that the sub-conscious mind operates without the limitations of rationality and social convention. It functions through intuition. This experiential emotional anchor in the child's life in Berne's(1961) term is called a “script”. Historically, scripts have been seen as artificial, limiting and involve parental programming. It is these characteristics of scripts that have led to a “school” of thought which suggests that autonomy involves being “script-free.” (McCormick and Pulleyblank, 1979). The second school of thought, English (1977), suggests that human beings are all programmed and limited, but scripts are artificial if the programming is “bad”. Without a script no one can exist. English (1977) states “Without a script, the Child Ego state would be operating only out of a vacuum of time and space within which there would be no content from which to connect the past to the future, so he would be rootless, like a leaf in the wind.” (p. 290). To him psychosis represents lack of script and hence total emotional disorganization. In addition, Vygotsky (1962) suggests that each newborn possesses “syncretic thought.” From day one, each individual sets about creating filters to limit one's thoughts, feelings and behaviors. For without this limitation, there would be only chaos of syncretism. Thus the scripts can be viewed as “filtering” mechanisms. The concept of transference: Of the various patterns of relationships, in professionpersonal continuum, a significant one is “therapistrelationship.” In interaction bond of a therapist and client, typically all therapies embrace the following features: a. Constancy of therapist's interest, irrespective of client's behavioral variations. This is the neutrality and well-integrated feature in therapist's personality. b. Suspension of moral judgment. The therapist is necessarily non-judgmental. c. Therapist's empathy, insight, understanding and acceptance indicating the therapist to be a good container having highest “holding” capacity. d. Client's opportunity to speak the unspeakable now; reliability of therapist in keeping appointments, the duration of the session, the attempt to put client's welfare first, the safe environment that the therapist's structure provides in which the client can regress. The features in an overall stand indicate therapist's capacity of providing a “psychological space of completely assured ambience” of non-criticality to open up the system of hidden aspects of mind to him/ her. e. The therapist allowing him/ herself to be used as a “transference object” without the interference of counter-transference. This hints at the self-confidence of the therapist who seems to be adequately knowledgeable and highly skilled at his/ her job. The hallmark of analysis is making the unconscious Sibling Jealousy 91

conscious. Since the therapist may not meet the needs of the client (the therapist cannot be perfect and know all the client's needs and wishes) and since the therapist does not act like the object of the transference (the therapist is not judgmental) like the object of the transference (the therapist is not judgmental like the critical parent, or uncaring like the neglecting parent), frustration results, promoting more regression. This allows for the examination of these feelings and examination of these feelings and exploration of the differences between fantasies and wishes versus acts. The observing ego learns more and more about what the whole person does. This is what makes analysis of transference so powerful. Freud first outlined the phenomenon of transference in 1936. In 1959, he stated, “In the hands of the physician, it (transference) becomes the most powerful therapeutic instrument and it plays a part that can scarcely be overestimated in the dynamics of the process of cure.” Ezriel (1950) views transference as “the residues of unresolved infantile conflicts which are transferred from the past onto objects in the present environment.” (p. 60) Silverberg (1948) noted that transference has been defined as either “embracing the whole affective relationship to the physician” or as “only a bit of repetition.” In the context, Horney (1939) discussed “good” and “bad” transference images and Rogers (1961) outlined various degrees of transference attitudes. Hence, transference refers to the unconscious influence of past learning of traumatic inter-personal relationships on present emotional responses, behavior and relationships. This maladaptive learning stems from childhood experiences and interferes with normal relationship and decision-making. They are new editions or facsimiles of the impulses and fantasies which are aroused and made conscious during the process of analysis. The main characteristic (of transference) is the experience of feelings to a person which do not befit that person and which actually apply to another. Essentially, a person in the present is reacted to as though he were a person of the past. Transference is a repetition, a new edition of an old object relationship. The person reacting with transference-feelings is in the main unaware of the distortion, which is necessarily a regressive process. Here, it should be acknowledged that: (a) Transference reactions occur in all clients undergoing psychotherapy. (b) Transference occurs in analysis and outside of analysis, in neurotics, psychotics, and in healthy people. (c) All human relations contain a mixture of realistic and transference reactions (Greenson, 1991). (d) Transference is the distinctive feature of psychoanalysis. (e) A special kind of object relationship – a repetition – a new edition. (f) Its components may be of any kind – feelings, desires, wishes, fears, fantasies, attitudes and ideas or defenses against them – it is unconscious. (f) Regression causes instinctual frustration and induces the person concerned to seek belated opportunities for satisfaction – these opportunities are found in analytic situation. (g) Transference reactions may be derived in later life from persons who perform special kinds of function which were originally carried by the parents. Thus lovers, leaders, authorities, physicians, teachers, performers, film actors and actresses are prone to activate transference responses. (h) Its general characteristics are repetition and inappropriateness. (i) Inappropriateness in transference is in terms of: intensity, ambivalence, capriciousness (floating transference), and tenacity or rigidity.Laplanche and Pontalis (1980) concluded that each definition of transference varies in relation to four areas: (1) specificity of transference; (2) the relationship between transference and reality; (3) the function of transference in treatment; (4) what is transferred. The common signs of transference are: (1)The client wants to be considered a friend. (2) The client treats the other as guru or an authority. (3) The client is concerned about not upsetting the other. (4) The client is overly curious about the other's personal life. (4) The client contacts the other excessively about personal matters. (5) The client expresses a desire for the other's approval, opinions, compliments etc. There are different types of transference such as: (1) Paternal transference – In this, the attention is turned to the other person into a father or an idealized fatherfigure. Fathers are powerful, authoritative and wise. They predict and tell the younger ones what to do. They know many things and provide a sense of control in the younger one's lives. They create sense of security. (2) Maternal transference - Relationships are developed with the mothers at much earlier dates and so take on roles of babies rather than children. Mothers are source 92 Sanyal

of unconditional love. Mothers too are source of authority and the threat of separation is very powerful. (3) Sibling transference – White (1984) stated that besides perceiving others as either parental or dependent figures, one can view their siblings or equal status figures. This is sometimes found in siblings who see each other as equal and occurs commonly with friends at school or other co-workers. (4) Unhealthy transference. According to Freud (1959), it has two wings: transference neurosis, and transference reaction. The former represents the whole of the client's pathological behavior that is manifested in his/her relationship with the therapist. Thus, the transference neurosis does two jobs (a) it coordinates the apparently unrelated sets of transference; (b) it permits the whole of the client's pathological behavior to be exposed by becoming related to the therapeutic setting, through the client's relationship with the therapist(Laplance and Pontalis, 1980). Transference neurosis is displayed in whole relationships where transference reactions are displayed via transactions of specific sets. In these unhealthy folds transference is viewed as that part of the libidinal impulses that has been held up in development, withheld from the conscious personality and from reality. This concept of transference includes the notions of unresolved infantile conflicts and arrested development. This transference supports the pathology in the individual. Healthy transference involves the results of resolved infantile conflicts, which are transferred from the past onto objects in the present environment. Moreover, this is not restricted to only client-therapist relationship, but occurs in many arenas of everyday life (Ezriel, 1950; Freud, 1959; Ruesch, 1961; Berne,1961, 1963). Script and Transference: Berne (1961) defined script as being a function of transference. To him, scripts are derivatives of infantile reactions and experience. Script is far more than just a collection of transference reactions; instead, it includes the story of one's life. In this, two levels of transference, i.e., transference reaction and transference drama or neurosis, the reactions form only one part of the whole drama. Berne (1961) viewed “subjects being in the realm of transference phenomena, that is, they are derivatives or more precisely, adaptations of infantile reactions and experiences. Script is the “root of transference” aimed at discouraging “hamartic scripts” and encouraging “Winners' Scripts.” In Winner's script formation, the 'configuration of positive events' and hence positive emotions together with proper identification with the parental figure is noticed. The ego becomes a matured one and develops a healthy filter to have its own comfortable script to lead one's life. Transference and script-imago/ the process of scripting: Freud (1959) in his paper on the dynamics of transference stresses that transference is connected with prototypes or imagos. The slots in the script imago are also prototypes. They are prototypes of how one can relate to parental figures, sibling or equal figures, and dependent or child-like figures. Metaphorically, these slots are seen as similar in nature to that of muscles. When constantly used, they grow, become pronounced, and are vital. Script imago slots when used constantly, also grow and become robust. Those slots not used atrophy, as does a muscle. They can never completely die away, yet when not used for long periods of time they become so insignificant, that they are virtually nonexistent. Script imago slots are expected to fully form from where three conditions are met: I) The child can observe others relating. The more affect-laden these others are, the more powerful the effect. ii) The child can practice relating first hand. This is usually done through play, sport and other everyday activities. iii) The child gets stroked for relating in certain ways. When a child does all three of these throughout her formative years, then he/ she will have robust and vital slots, whether they be parental figure slots, equal figure slots or dependent figure slots. The great majority of people have at least one wellformed parental figure slot, because most children have a great deal of practice relating to a parental figure. Also the strokes in that relationship are usually quite intense. Hence conditions (ii) and (iii) are easily met, as is probably condition (i) for most children. Sibling Jealousy 93

Sibling figure slot formation is also based on the three conditions given above. If the child is permitted access to other children of about her own age, then she will be able to practice various styles of equal/ equal relating, make observations of others and get stroked for that relating. In such a situation in adult life, he/ she will find it easy to develop relationships with those she perceives as equals. The relationship may be healthy or pathological, depending on the quality of the relationship when (s)he was young. In fact, the best way parents can deal with their offspring's equal relationships is by providing them with a wide cross-section of equal figures to relate with, by remaining aloof when they are actually playing (ie., relating), and by stroking the health-promoting friendships they develop. Again, the best things parents can do is to provide good role models, provide the offspring with access to dependent figures, remain aloof during the practice, and stroke healthy relating. Logically then, the concepts of the “permission matrix” and the decision scale presented by Woolams and Brown (1978) imply that the child's decision to trust is also placed in the Parent of Child, when it became routinized. Such a healthy decision is then transferred into the parent just as are pathological decisions. Consequently the permission matrix seems equivalent to a Winner's script. Transference in relationships: White (1984) noted that there are three ways to perceive another individual: 1. As a parental figure(If this is negative, there would be more comparison by self and others). More sense of inadequacy, inferiority 2. As an equal or sibling figure: Jealousy towards peers 3. As a dependent: No identification with children and to act as their caregiversor child figure. The transference neurosis and transference reactions occur in response to parental figures; that is why the parental figure slots in the script imago diagram can be renamed the transference slots. Freud (1909) states that it is the client's relationship with his parental figures that are once again lived out in the transference. Parental figures need not be biological parents but can also be others such as older siblings and friends. The vast majority of clients view therapist as parental figures, which means that they place the therapist into the parental figure slot and form a transference neurosis. 94 Sanyal Fig. The script imago

Sibling Jealousy 95 Countertransference is also the result of unresolved conflicts. Tauber (1954) views counter-transference reactions as being due to blind spots, private needs, irrelevant attitudes, biases or moral prejudices on the part of the therapist. It is transference of unresolved infantile conflicts from the past onto the present. Just as transference occurs in response to parental figures, counter-transference occurs in response to dependent or child-like figures. Starke (1973) states that countertransference often takes the form of a projection on to the patient of an attitude adopted by the analyst towards his own children. In fact, the formation of a transference neurosis and reactions allow ones to structure a relationship with parental figures. The advent of the counter-transference neurosis and reactions provide structure for a relationship with dependent figures. Thus it seems necessary to define a third type of transference, which is called sibling-transference without which we cannot structure a relationship of neurosis or reactions with equals or peers. Sibling transference only occurs in an equal/ equal relationship. Consequently it sometimes occurs with siblings and sometimes not. Hence it is at times re-named as “equal-status transference.” Equal status transference: While (1964) states that besides perceiving others as either parental or dependent figures, one can view them as siblings or equal status figures. This is sometimes found in siblings who see each other as equals and occurs commonly with friends at school or other coworkers. A script enables us to structure a relationship with others. Most of the people have “good” and/ or “bad” relationships with others who are seen as being of equal power or status. These relationships are based on resolved and unresolved infantile conflicts (which occur in response to other equals in our early years); these are then transferred from the past onto objects in the present. Siblings can be annoying and restrictive just like parents can be, yet the most common feature of this form of transference is usually “competition.” Contextually subscription to Freud's psychosexual theory of personality development offers the explanation that this form of transference is seen to gain its genesis with the advent of the “Oedipus Complex.” With male children, the boy will alter his perception of the father by seeing him more as a competitor than a care-taker when the Oedipus Complex begins. He may at other times view the father as a caretaker/ parent. Thus, it illustrates the point that it is possible to view the same person in more than one transference slot. The relationship that develops between the father and the son during this stage is expected to determine the quality of relationships the son will have in adult life. Of course, he will establish other sibling figures in his formative years and these also will determine how he will relate to equals in later years of his life. Similarly, in the therapeutic setting, the formation of a sibling-transference neurosis and sibling-transference reactions will be based on the past history of the client and the therapist. If the client views the therapist as an equal, then these will develop. Alternatively, if the therapist views the client as an equal, then these will also occur in the therapist's reactions to the client. Understanding human relationships: Relationships are often much more complex than they are thought of; specially intimate relationships which bring to the surface the unmet needs, anxieties and unresolved conflicts with individuals from one's past, caretakers, friends and of course former intimate relationships. In fact, the relationships with other people are projections of the relationships one has within oneself. The external relationships and the internal relationships are in fact the same relationships. They only seem different because one looks at them through different lenses. Sharpening and deepening one's awareness regarding what one is are doing and how one is doing it, can help the people change their behaviour in ways that make a relationship more nourishing and supportive and less toxic and painful. A clearer perception of present existential reality can help individuals move toward doing a better job of meeting one's own (and often the other person) needs. Sibling relationship: In order to pave the smooth paths of adult interpersonal contexts, researchers have been interested in childhood sibling relationships studying sibling attachments, rivalry, birth-order and many other related topics. Sibling interactions are among the most important influences throughout a person's lifetime. Therefore it is important to understand the relationship of negative

96 Sanyal sibling interactions, i.e., sibling conflict to psychological distress. The sibling relationship is usually the longest relationship that an individual will experience in his/her life time (Cicinelli, 1995). Siblings begin to affect one another from the first day that they are introduced. Sibling relationships are unique because they are ascribed through birth or marriage rather than chosen relationships. The bond creates experiences that are most likely to nurture children's social, cognitive and psychological development. There are two theories to explain the continuity thread of sibling relationships in adulthood. One is based on the norms that parents teach their children. Parental promptings make sib-bonds imperative. Second theory is based on attachment concept. Siblings feel comfortable in attached relationships. Real or threatened separations upset them. Types of sibling relationships: Gold (1989) as cited in Cicirelli (1995) described the following types: (a) The intimate – matured ego products, (b) The congenial – matured ego products, (b) The loyal – super ego borne, (c) The apathetic – victims of comparison, low self-esteem, inferiority, more prone to transference reactions, and (d) The hostile - victims of comparison, low self-esteem, inferiority, more prone to transference reactions. Intimate siblings are specially close and extremely devoted. They value their relationships above all others. Congenial siblings are friends. They are close and caring but place higher value on marriage and parent-child relationship. Loyal siblings base their relationship on their common family history. They maintain regular, periodic contact, participate in family gatherings and support each other during times of crisis. Apathetic siblings feel indifferent toward each other. They rarely are in contact. Hostile sibling relationships are based on anger, resentment and very negative feelings. Sibling relationships during childhood are characterized by conflict and rivalry for parental attention and affection. Sibling conflict may arise from competition, social comparison, differences in values and opinions. The degree of such conflict may be associated with distress. Sigmund Freud saw the sibling relationship as an extension of the Oedipus Complex, where brothers were in competition for their mother's attention and sisters for their fathers. Alfred Adler saw siblings' “striving for significance” within the family and felt that birth order was an important aspect of personality development. David Levy introduced the term “sibling rivalry” in 1941, claiming that for an older sibling, “the aggressive response to the new baby is so typical that it is safe to say it is a common feature of family life.” Rivalry in childhood consists of vying for power and recognition between siblings and vying for parents' attention, recognition, approval and love. But despite their jealousy towards on another, they may still develop close relationships, if jealousy is resolved with appropriate intervention. This resolution is very much needed, otherwise this affects further social emotional interactions negatively in adulthood. Jealousy: Typically it refers to the thoughts, feelings, and behaviour that occur when a person believes a valued relationship is being threatened by a rival. This rival may or may not know that he/she is perceived as a threat. Nothing can ruin a relationship faster than jealousy. Jealousy creates anxiety, anger, loneliness, hate, fear. No one thinks clearly when jealous. Having a relationship with a jealous person is tough. The jealous person acts untrusting or unworthy. Jealousy makes the person unattractive, even repulsive. It seems to be “parental favouritism” and “differentiating attitudes.” Children are thus sensitive to differences in parental treatment. Competition among siblings, though often subtle, is a normal part of family life. Brothers and sisters often compete for everything from love and attention to praise and rewards. Often the competition is not openly recognized or acknowledged, but instead subtly permeates family dynamics. Parents do not realize, for example, that when they offer a reward to the child without any cavities, they have created a situation that can be perceived as some sort of unspoken contest among siblings. There is a consensus among clinicians and developmental psychologists that the sibling bond is complicated, fluid and influenced by many factors, such as: .parental treatment; Genetics; Gender, Life events, Ethnic and generational patterns, and people and experiences outside the family. All contribute to the success or failure of a particular sibling.

Sibling relationships and well-being: Investigators have been interested in the effect sibling relationships on well-being throughout adulthood. Cicirelli (1995) found that “the perception of a close bond to sisters by either men or women was related to well-being, as indicated by fewer symptoms of depression, while a close bond to brothers seemed to have little relevance for well-being.” (p.63). It seems probable “that women's emotional expressiveness and their traditional roles as nurturers account for the importance of relationships with sisters. (p.64). Analytically, thus, the sisters turn out to be good mothers, socially and emotionally and act as good “containers” in life (Bion, 1950). Siblings provide different types of support for each other as they age. As losses increase with age, siblings rely on each other more and more for social support. Goelting (1986, as cited in Cicirelli, 1995), believed that the amount of help that siblings give each other during adulthood and old age is based on their childhood and adolescent relationships. Conclusion: Hence, it is well surmised that since relationship context are obvious elements of social-emotional life, care needs to be taken to give them a healthy shape. Not only do children bond to parents, also parents do bond to children and those of equal status can also develop some bonding pattern. Greenacre (1954) opines that “relationships may be of a healthy nature or a pathological nature.” The duty of the conscious self, in the parental or caretaker role, is to look into the steps and contents to usher in health-concept there, so that society in general breathes happiness. References: Berne, E. (1961). Transactional analysis in psychotherapy. Bantam: New York. Berne, E. (1963). The structure and dynamics of organizations and groups. Ballantine: New York. Bion, W. R. (1950). The imaginary twin. Read to the British Psychoanalytic Society, Nov. 1, 1950. Cicirelli, V. G. (1955) Sibling relationships across the life span, NY Plenum NY. English, F. (1977). Beyond script analysis in G. Bernis, (Ed.) Transactional analysis after Eric Berne. Harpes, London. Ezriel, H. (1950). A psychoanalytic approach to group treatment. British Journal of Medical Psychology, 23, 59-74. Ezriel, H. (1950). A psychoanalytic approach to group treatment. British Journal of medical psychology, 23, 59-74. Freud, S. (1909). Notes upon a case of obsessional neurosis.In Collected Papers, Vol. 3, Basic Books; New York. Freud, S. (1936). Studies in Hysteria. Nervous and Mental Disease Publishing Company: New York. Freud, S. (1959). The dynamics of the transference in Collected Papers, Vol 2, Basic Books: New York. Fumihiko, T., Nobutaka, K., Yoshinaga, A., Rie, K., & Masahiro, S. (2000). A methodology of psychoanalysis approach for interpatient relation in clinical practice.The Journal of Japanese Association of Occupational Therapists,19, 2, 112-119. Greenacre, P. (1954). The role of transference: Practical considerations in relation to psychoanalytic therapy. Journal of the American Psychoanalytic Association, 2, 671-684. Greenson, R. R. (1991). The Technique and Practice of Psychoanalysis : A Memorial Volume to Ralph R. Greenson (Monograph Series of the Ralph R. Greenson Memorial Library of), International Universities Press Inc. Horney, K. (1939). New ways in psychoanalysis. Norton: New York. Laplanche, J., & Pontalis, J. (1980).The language of psychoanalysis. Hogarth, London. McCormick, P. and Pulleyblank, E. F. (1979).A more comprehensive life script interview. Transactional Analysis Journal, 9, 234- 236. Rogers, C.R. (1961). Client centered therapy. Houghton: New York. Ruesch, J. (1961). Therapeutic communication. Norton: New York. Sandler, J., Dare, C., & Holder, A. (1973). The patient and the analyst: the basis of the psychoanalytic process. George Allen and Unwin Ltd., London. Silverberg, W.V. (1948). The concept of transference. PsychoanalyticQuaterly, 17, 303-321. Starke, J. G. (1973). The validity of Psychoanalysis. Angus and Robertson. Tauber, E.S. (1954). Exploring the therapeutic use of countertransference data. Psychiatry, 17, 331-336. Vygotsky, L.S. (1962). An experimental study of concept formation.In Vygotsky (Ed.).Thought and Language. M.I.T. Press. While, T. (1984). New ways in Transactional analysis. Omega. Distributions: Western Australia. White, T. (1984). Relationship analysis. Proceedings of the Loftus, Street Seminar, 3, 32-42. Wilson, C. (1972). New Pathways in Psychology. Trinity Press: London. Woolams, S., and Brown, M. (1978). Transactional Analysis. Huron Valley Institute Press. Michigan. Sibling Jealousy 97

Early Abusive Experiences and Psychological Consequences: a Study with Institutionalized Children Pritanka Mondal and Sanjukta Das Children without parental care are in high risk for abuse and neglect. Hence large number of these children ends up in institutional care. Inadequate individual care may cause social and emotional impairment in children; maltreatment may also influence the child's psyche. The lack of trust in primary bonding may be a possible precursor to the victim becoming an offender. The objective was to explore the psyche of the abused children and further find out whether there is any difference in psyche of sexually abused and neglected children through projective technique. The sample consisted of participants10 boys and girls. Amongst them 5 are with history of sexual abuse and 5 are with experience of neglect. All the participants were from low socio economic background. Indian adaptation of Children Apperception Test Animal Form (Chaudhry, 1967) was used. Result indicated that childrenareinhibited and withdrawn in interpersonal relation. The common pattern of response reported was displaced aggression towards significant person in life. Sexually abused children showed morbid fears for strangers and difficulty in social adjustment. The neglected group found the environment resource less. Overall findings suggest that psychological deprivation has a significant influence in the psyche of the child. Psychological insight to the psychosocial problem associated with abusive experiences may enrich the provision for psychological assistance to the children. Childhood period is characterized by continuous curve of maturity where the child learns various skills to shape his or her own reality. There are numerous children who show a very irregular pattern in their growth. Such imbalance between developmental lines causes sufficient disturbances in childhood (A Freud,1949). India is home to the world's largest population of street children, estimated at 18 million. These children are often brought under Institutional Care. Institutes that provide residential care aim at changing the street children's attitudes to their circumstances. In Indian socio-cultural context child abuse and neglect is also a burning issue. The causes and consequences of this maltreatment are socio-cultural and as well as psychological; it has an enormous impact on the psyche of the child (Emery & Laumann-Billings2002; Friedman & Chase-Lansdale, 2002; Douglas 2006; Crouch and Behl, 2001; Gilbert et al, 2009). Deprived self in the background of maltreatment gives rise to aggressive and abusive tendencies in individuals which lead to victimized social life. As per World Health Organization (WHO,1999): ''Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power.'' Children who experience abuse have deleterious effect in their psychological development. These are reflected through their emotional and behavioural expression. Researchers have noted that these children typically (over 70%) showed mood related problems such as anxiety, excessive crying and sadness (Layzer, Goodson, and delange 1985; Dubowitz, Papas, Black, & Starr, 2002; Teicher, 2000; De Bellis& Thomas, 2003; Springer, Sheridan, Kuo,&Carnes, 2007). These children are considered as emotionally needy. It was found that boys with abuse experience were more likely to become defiant and destructive, acting out their aggression and experiencing confusion. Young girls, in contrast, were noted to be more clingy and dependent ( Hughes ,1982;Augoustinos, 1987; Briere&Runtz, 1988, 1990; Claussen& Crittenden, 1991; Kaplan, Pelcovitz&Labruna, 1999). Neglect has been described as the "most serious type of child maltreatment and the least understood" (Dubowitz, 1999 p.67). Neglect was shown to be a strong predictor of some dimensions of psychological functioning and general psychological problems (Gauthier et al., 1996, Turney and Tanner, 2005; Daniel et al., 2011). The child, in its course of development, internalizes its primary experience with the caregiver. The infringements of the biological mother- infant tie is found to give rise to separation anxiety (Bowlby, 1960).When the mother fails to play the role as a Pritanka Mondal, Research Scholar, University of Calcutta, pritanka.mondal@gmail.com and Sanjukta Das, M.Phil (M&SP), Ph. D, Associate Professor, University of Calcutta, Email: sanjuktahope@gmail.com Key Words: Abuse, child's psyche, aggression. Email:

reliable need-fulfilling and comfort-giving agency it leads tobreakdowns in individuations (Mahler,1952) or manifestation of deprivation (Alpert,1959). Where the libidinal relations are unsatisfactory due to unstable or unsuitable love objects, disturbance in the balance betweenlibido and aggression is noted which in turn gives rise to uncontrollable aggression, destructiveness(A. Freud, 1949). In the view of this existing literature and social scenario the present study focused on the psychological consequences of early abusive experience including children with history of sexual abuse and neglect.The study was conducted in an institution in Kolkata. Permission from authority and due consent from the participants was taken. The number of participant was 10. The age range of the participants was between 7- 10 years. The participants were staying in the institution at least for a period of 2 years. The boys and girls were from low socio-economic background and are destitute children. The participants are at present attending school under the institution's care. They occasionally meet their family members but do not stay with them. In the present study purposive sampling technique was used. Child Abuse 99 Table 1 Description of Sample Age Previously stayed at Nature of abuse Male 8 years pavement Sexually abused 9 years village Sexually abused 10 years pavement Neglect 7 years pavement Neglect 7 years Red light area Sexually abused Female 10 years Red light area Sexually abused 9 years village Neglect 9 years village Neglect 10 years pavement Neglect 9 years pavement Neglect Children's Apperception Test, Animal Form (CAT- India adaptation by Dr. Uma Choudhury (1967) was administered to the 10 participants. It is a projective test. The CAT uses the apperceptive method of investigating the personality by exploring the underline dynamic difference. The information regarding the family condition of each child was collected through semi-structured interview schedule .On the basis of interview those children who were found to be living in vulnerable (neglected or high possibility of abuse or have already undergone the maltreatment) condition were approached. Among them 5 boys and 5 girls shared their experience of sexual abuse and neglect prior to their coming in the institution. The identities of the participants are kept confidential. The participants were interviewed regarding their abused experience. Duration of data collection: April 2010- December 2011.The data were interpreted from psychoanalytical perspective by two experts independently and those points they agreed upon were included as current findings. Discussion: Overall findings suggest that psychological deprivation has a significant influence in the psyche of the child.

100 Mondal & Das Table 2 Major findings of Children's Apperception Test (CAT) stories of two groups of children AREAS of CAT MAJOR FINDINS (Neglect) MAJOR FINDINGS (SEXUAL ABUSE) Main theme No family cohesion. Deprivation of basic needs. Relationships are untrustworthy. Deprivation of basic needs The main hero Helpless, Undirected self. Helpless, Undirected self, sadness Main needs of the hero Need for power& Dominance. Need for nurturance and Succorance, Need for affiliation Need for freedom, Need for nurturance, Need for affiliation, Need for power& dominance Conception of the environment(world) Neglecting and unforgiving Stressful Stressful, Threatening, Neglecting ,Hostile Unforgiving Figures seen as Male/Female figures are rejecting. Authority male/female figures are abusive. Female figures are neglectful and rejecting. Authority male figures are abusive,untrustworthy Significant conflicts Affiliation vs. vulnerability (due to underline mistrust and nonconformity) Autonomy vs. compliance Autonomy vs. compliance. Affiliation vs. venerability.(due to underline mistrust and nonconformity) Nature of anxieties Loss of love and affiliation. Separation anxiety Castration anxiety ,Loss of love and affiliation. No warmth in relation Adequacy of super ego (punishment for crime) Superego is not adequately developed. Superego is not adequately developed. Integration of the ego Poor impulse control/ egocentricity Poor impulse control/ egocentricity The age and the duration of abuse are very important. In India the peak age is 6-11 years (Hunter et al.2000; Tang1998; Straus& Hamby,1997).The experience of abuse and neglect at a young age when the psyche is developing has an impact (Frederico et al., 2008; Ryan et. al ., 2013). The data from National Survey of Child and Adolescent Well-Being (NSCAW) reports that majority of the children come under foster care due to neglect; the next largest group due to physical abuse and a smaller number due to sexual abuse. In India apart from these causes, children come under institutional care sometimes due to their parent's inability to take care of them, abandonment by parents or family separation, etc. Therefore, the child's development is contingent upon various factors within the family. The family instability such as poverty, neglect etc, is a precursor to various maltreatment of the child. Children experience emotional and behavioral problems due to family violence such as aggressiveness, anxiety and it reflects in how the child socializes with friends, family, and authorities(Dodd, 2009). A safe and secure environment with stable attachment is reported to reduce the effect of maltreatment (Mc Loyd, 1998). The child is then able to develop a sense of trust and wellbeing which lays the foundation for mental health.Young children with secure attachment derive their security from the conviction that the mother (or attachment figure) is relative and available when needed. This is defined as confidence in protection, (Goldberg, Grusec, &Jenkins, 1999). Beside these socio-economic causes, maltreatment alone has a significant impact on child development. The mental structure is based on the interaction with id, ego and super ego. Each of the agencies has its individual role to play. When all the agencies function together it lays the foundation of a mental health. In the present study the lack of care and experience of unavailability of significant caregiver is evident in the two groups of abuse .The common pattern of response reported by both the groups was aggression which is mostly undirected. In dealing with the stress they are more aggressive and disruptive. The coping mechanism that they are utilizing to overcome this stress show underline depression they are suffering from. In a 1998 review of related literature, Mullen and

Child Abuse 101 Fleming stated that significant damage done by child sexual abuse affects the child's developing capacities for trust, intimacy, and sexuality; research further indicates that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects. Judy &Rita, (2013) reported that there is a strong association between childhood sexual abuse and adverse outcome throughout lifetime on mental health, social, sexual, interpersonal and behavioural as well as physical health consequences. Previous study by Abdul Rehman& De Luca, in 2001, indicates that sexually abused child as adult has difficulty in social adjustment. In the present study comparisons between the two groups reveal certain findings. In the present study sexually abused children showed morbid fears for strangers and difficulty in social adjustment. The neglected group was inhibited and restricted in social relationship. In dealing with their conflicts and anxiety they experience extreme helplessness. Research by Mills in 2004, have indicated that the earlier the children are maltreated, the more are they likely to develop behavior problems.Abuse and neglect is associated with being sad, isolated and depressed and externalizing behaviors such as aggressive or hyperactive throughout childhood. Similar findings were reported by Ethier et al., 2004; Shaffer, Huston, &Egeland, 2008. In both the group of maltreatment few findings have a different connotation. The underline expression of the actual cause is taken into consideration to bring forward the psyche structure. As for the sexually abused group present the need for freedom is the demand for an unrestricted expression of impulses which are kept at bay due to lack of trust. They are incapable to from any relation. They continuously feel afraid to seek love and care as they have experienced exploitation and aggression from significant others in their life. It makes them feel more vulnerable which generates a sense of helplessness associated with an empty feeling which remains insatiable through any pleasurable condition. On the other hand the neglected group perceives the environment resource less. This sense of helplessness is a feeling of having nothing within self to fight against the situation. This inability makes the self- associated with feelings of worthlessness. They want to compensate for this feeling by acquiring privileges from others. But they never get satisfaction as it is not able to erase the inner insecurity which was caused by early experience of deprivation. This feeling is very much interlinked with their insatiable empty feeling in the self. Psychological mechanism to compensate inner weakness results in the sense of a sense of omnipotence which is manifested by their need for power and dominance which is very much evident from their CAT stories. In both the group the psyche is characterized by underlying aggressions which disintegrate the self and makes it feel helpless. It is like a vicious circle. The self becomes fragmented, which in turn, leads to appraise social situation around it in a very idiosyncratic manner and takes defensive armor to safeguard the self from further disintegration. This becomes very obvious in their behavioural pattern. They either become too aggressive or shy away while dealing with stress. As for both the group the superego is not formed properly due to unavailability of proper role model, it is very difficult for them to make a sound moral judgment. So they are at high risk for abusing others. Overall, the entire trauma in their life is making them prone to victimized social life. To them, a sense of power is very essential. In this way they slowly begin to identify with the aggressor. The identification with the aggressor helps them to be active and threatening rather than being passive and threatened. So the whole psyche oscillates between the two continuums. Their victimized social life is insidiously turning them into offenders. (English, Widom, &Brandford, 2004; Frederico et al., 2008). The aggressive act outs are the reaction to stress. In the present context the ego is overwhelmed with traumatic experience. The enormous psychic anxiety caused by basic mistrust further induces trauma in the child's psyche. The impoverished ego (without any pleasure) becomes apprehensive. The perception of insecure, unprotected environment affects the internal representation of the outside world which generates enormous anxiety and frustration. Insecure appraisal of situation affects the individual personally and negatively (Davies& Cummings, 1995). Conclusion: The main focus of the study was to highlight how the inner world of the abused children is functioning. This

102 Mondal & Das perception of the world tends to transform these children into hostile, violent and unpredictable persons. The abuse experiences have resulted in anticipation of pain or injury from others. They behave in ways to incite pain and injury, distrusting closeness, feelings of helplessness and powerlessness, and the development of wariness or suspicion of others. They have restricted themselves in their ability to perceive their own feelings and have difficulty in interpreting and responding to the emotional expressions of others. Due to the abuse, they have developed a pattern of denying or restricting certain emotional responses and expressing only those with which they are most familiar i.e. aggression and hostility so as to get what they want. Therefore, the child's chances of remaining mentally healthy are closely connected with his reaction to displeasure which is released whenever the needs are not satisfied. 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Stress, Coping and Emotional Processing in Chronic Pain: A Comparative Analysis Ushri Banerjee, N.K. Bhattacharya and NilanjanaSanyal The present study has attempted to assess daily hassles stress, coping and emotional processing in two groups of Chronic Pain patients- viz. Chronic Headache and Chronic Low Back Pain and further compared the groups with a Normal group. The sample comprised of 22 patients suffering from Chronic Headache (CH) (Group 1),18 patients suffering from Chronic Low Back Pain (CLBP) (Group 2) and 20 matched Normal Controls (NC) (Group 3).They were administered Daily Hassles Checklist (Basu,2005), Ways of Coping Questionnaire (Folkman& Lazarus, 1985) and Emotional Processing Scale (Baker et al. 2007). The results obtained were analysed by using Mean, S.D., Rank-Difference Coefficient of Correlation and Kruskal- Wallis One Way ANOVA as well. The obtained findings revealed that the CH and CLBP groups differed on the Escape Avoidance and Planful Problem Solving subscales of Coping as well as on the total Emotional Processing scores and its subscales- Signs of Unprocessed Emotion, Unregulated Emotion and Impoverished Emotional Experience. The CH and NC groups differed significantly on Escape Avoidance subscale of Coping and Avoidance and Impoverished Emotional Experience subscales of Emotional Processing. The CLBP and NC groups differed significantly on Signs of Unprocessed Emotion subscale of Emotional Processing. Significant relationship was found between certain subscales of coping and some of the factors of Emotional Processing for the CH and CLBPgroups. Ushri Banerjee, Asst. Professor (Corresponding author Email: ushribanerjee@gmail.com ) and N. K. Bhattacharya, Retd. Professor, Department of Applied Psychology, University of Calcutta and Prof. Nilanjana Sanyal, Dept of Psychology, University of Calcutta, 92, A.P.C. Road, Kolkata-700 009 Key Words: Chronic back pain .Over the years chronic pain has found a steady place in 'chronic diseases' worldwide. Each year number of people is increasing in this category, thereby portraying a dismal picture of distress, disability, loss of time, resources, and money. Watkins et al. (2008) found the prevalence rates to be 15% in Canada; 19% in Denmark; 24.4% in Norway; 23.4% in Spain, 50.4% in the UK; 19% in Europe and 19.1% in Australia. Research findings have pointed out that there are certain chronic pain conditions for which there are no confirmatory laboratory studies and diagnostic investigations are incapable or insensitive to detection of any organic pathology that explains the chronic pain condition. These include neuropathic pain, headache, chronic low back pain, fibromyalgia etc. (Flor and Turk, 2011; Chaturvedi,2009). Chronic Pain is a condition in which pain persists beyond 3 months and/or in which pain persists for longer than expected time and on most occasions either no organic basis is present or the degree of pain is proportionately greater than the organic findings obtained, if any.The International Headache Society (IHS) categorised primary headache disorder into four groups including Migraine and Tension-type Headache. Tension headache is a condition characterised by a pain that has a pressing and tightening quality that is bilateral and often described as bandlike or surrounding the head. It is thought to be associated with physical and psychological stress. Migraine Headache is the commonest cause as far as severe episodic recurrent headache is concerned. The basic difference with tension headache lies in it being unilateral and has got a pulsating quality. Chronic back pain is mostly located in the lumbosacral and posterior neck region. Low back pain (LBP) is defined as pain in the low back that persists beyond 12 weeks. Common causes of back pain are intervertebral disc rupture, Infection, Tumour, Trauma, Prior surgery, Lumbar injury etc. Several researchers have pointed out that psychological events are considered as risk factors for the development of chronic pain. Chronic pain such as Back pain, Headache or Fibromyalgia may persist despite efforts to overcome it and cannot always be explained by organic pathology (Flor& Turk, 2011). Stressors are considered as those events, experiences or circumstances that have the potential to create disturbance in an individual's life. Lazarus (1984) pointed out that day-to-day minor stress has immense significance for predicting stress manifestations. Daily stressors are continuous in nature (Pearlin et al.,1981) and are characterised as those irritating, frustrating as well as distressing demands that to a certain extent are an integral part of our everyday transactions with the environment (Kanner et al., 1981). Daily Hassles include such events as losing things, traffic jams, bad

weather, and relationship problems as well as family and financial concerns. “Coping is a constantly changing cognitive and behavioural effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Lazarus and Folkman,1984). Coping encompasses a range of personal dispositions including stable and enduring traits, habitual styles or behavioural patterns as well as situation specific cognitive and behavioural efforts that mediate stress. Coping has been found to be strongly linked to psychological outcomes than to physical health (Clark, 2006; Penleyet al., 2002). Overt coping strategies include rest, medication, relaxation, professional help, discussion with friends while covert ones are those which includes distracting oneself from pain, seeking information, problem solving etc. Rachman (1980) first introduced the concept of emotional processing. He defined it as “... a process whereby emotional disturbances are absorbed and decline to the extent that other experiences and behavior can proceed without disruption” (p.51). He hypothesised that if emotional disturbances are incompletely processed, then signs of this failure will emerge in the form of intrusive memories, nightmares, over-arousal, agitation etc. These “signs of failure” might be understood as “symptoms” of psychological disorder (Rachman, 1980). Baker in 1998 began to specify the different mechanisms involved in emotional processing which eventually gave rise to an Emotional Processing Model. In general research has revealed that deficiencies in emotional processing are associated with psychopathology. These include increased rumination, avoidance and maladaptive coping in mental health problems (Gross, 1998; Gross & Munoz, 1995). The present study thus makes an attempt to assess and compare the dimensions of daily hassles stress, coping and emotional processing among chronic pain groups and normal control group. Materials and Methods: Sample: The present study was conducted on 22 patients suffering from Chronic Headache (CH), 18 patients suffering from Chronic Low Back Pain (CLBP) and 20 matched Normal Controls (NC). The patients suffering from chronic low back pain and those suffering from chronic headache (beyond 6 months) were diagnosed by concerned physicians, considered as lacking in significant pathology underlying the pain state and referred by orthopaedics, psychiatrists, pain specialists, physiotherapists, general physicians and anaesthesiologists. Purposive sampling was used to collect the data.The normal control was matched in terms of age, sex, level of education and level of income. Thus patients and non-patients were in the age range of 25 to 43 years with a minimum of 10+ 2 educational level and had a family income between Rs.35, 000- Rs.45,000 per month. Individuals with any history of psychiatric and/organic disorder were excluded from the study. Tools: The following tools were used to assess daily hassles stress, coping and emotional processing. 1. Daily Hassles Checklist (Basu,2005): Basu (2005) devised the Daily Hassles Checklist to measure the daily hassles encountered by individuals. The Checklist measures the daily hassles or stress producing events which may be faced by married working individualsboth men and women. It comprises of 50 items describing a broad range of daily hassles. The higher the score the greater is the number of daily hassles encountered, thus greater is the stress caused. 2. Ways of Coping Questionnaire (Folkman& Lazarus, 1985):The 66 item version of the Ways of Coping Questionnaire comprises of a broad range of cognitive and behavioral strategies that individuals use to cope with the stressful encounters of everyday living. It consists of 8 subscales described as follows: Ÿ Confrontive Coping: Aggressive efforts to alter the situation and involves some degree of risk taking. Ÿ Distancing: Cognitive efforts to detach oneself and to minimize the significance of the situation. Ÿ Self- Controlling: Efforts to regulate one's feelings and actions Ÿ Seeking Social Support: Efforts to seek informational, Chronic back pain 105

tangible and emotional support Ÿ Accepting Responsibility: Acknowledges one's own role in the problem with a concomitant theme of trying to put things right Ÿ Escape-Avoidance: Wishful thinking and behavioral efforts to escape or avoid the problem. Ÿ Planful Problem Solving: Deliberate problem-focused efforts to alter the situation, coupled with analytic approach to solving the problem. Ÿ Positive Reappraisal: Efforts to create positive meaning by focusing on personal growth along with a religious dimension. 3. Emotional Processing Scale (Baker et al., 2007):The EPS has been developed based on the emotional processing model put forward by Baker (2001) along with clinical experience, case histories and autobiographical studies as well as literature from clinical psychology and emotion research. It consists of 25 items and 5 factors. The factors are: Ÿ Suppression: Excessive control of emotional experience and expression Ÿ Signs of Unprocessed Emotion: Intrusive and persistent emotional experiences Ÿ Unregulated Emotion: Inability to control one's emotions Ÿ Avoidance: Avoidance of negative emotional triggers Ÿ Impoverished Emotional Experience: Detached experience of emotions due to poor emotional insight Procedure: The patients and non patients who met the Inclusion criteria were included in the study. Informed consent was obtained from the participants and their confidentiality was maintained. Both the pain groups and the normal subjects were administered individually the Daily Hassles Checklist, Ways of Coping Questionnaire and Emotional Processing Scale.The data collected was analysed by using SPSS Version 10.The Mean, S.D., Kruskal-Wallis One-Way Analysis of Variance, Mann –Whitney U Test and Rank Difference Coefficient of Correlation was calculated for all the variables across the three groups. Results: Table 1 Mean and SD of different variables of Chronic Headache (CH), Chronic Low Back Pain (CLBP) and Normal Control (NC) Groups 106 Banerjee et.al. Variables CH CLBP NC Mean SD Mean SD Mean SD Daily Hassles 14.18 3.74 15.61 4.78 15.10 4.44 Confrontive Coping 19.51 5.18 23.86 3.24 19.51 4.45 Distancing 20.84 4.21 21.02 4.13 21.08 5.30 Self-Controlling 23.02 3.62 23.52 5.00 21.66 3.90 Social Support 19.22 7.41 18.56 4.95 19.61 8.15 Accepting Responsibility 18.72 7.51 17.92 7.01 19.09 6.51 Escape Avoidance 18.09 5.02 14.32 4.96 14.9 41.9 Planful Problem Solving 21.30 4.00 25.00 3.95 22.82 3.26 Positive Reappraisal 21.38 5.67 20.36 5.90 22.46 5.05 Emotional Processing- Suppression 5.15 1.67 5.3 2.39 5.52 1.19 Signs of Unprocessed Emotion 5.57 1.39 4.07 1.71 5.24 1.27 Unregulated Emotion 4.38 2.0 2.81 1.88 3.62 1.03 Avoidance 5.87 1.64 4.85 2.42 4.87 1.49 Impoverished Emotional Experience 4.3 1.49 3.60 2.00 3.51 1.25 Total Emotional Processing Score 5.05 1.04 4.07 1.09 4.59 .76

Table 1 showthat daily stressors are experienced by the CLBP group maximally closely followed by the NC group. When the scores of the Coping scale are concerned, the highest among the different subscales are explained below- the CH and NC groups obtained equal scores in the Confrontive Coping subscale while in the Distancing subscale highest score was obtained by NC group and for the Self-Controlling subscale the highest score was obtained by the CLBP group and the NC group obtained the highest score in the Seeking Social Support subscale. In the Accepting Responsibility subscale the highest has been obtained by the NC group, in the Escape Avoidance subscale by the CH group, in the Planful Problem Solving scale by the CLBP group and in the Positive Reappraisal scale by the NC group. As far as Emotional Processing is concerned the NC used Suppression maximally in comparison to the other two groups. The CH group showed maximum Signs of Unprocessed Emotion as well as Unregulated Emotion, Avoidance and Impoverished Emotional Experiences. Chronic back pain 107 Table 2 Findings of Kruskal-Wallis One-way Analysis of Variance by Ranks for significance of difference between Chronic Headache, Chronic Low Back Pain and Normal Control Groups on different variables Variables H Value (df=2) Daily Hassles Stress .83 P=.66 Not Significant Coping- Confrontive Coping 2.92 P=.23 Not Significant Distancing .35 P=.84 Not Significant Self-Controlling 2.32 P=.31 Not Significant Seeking Social Support 1.51 P=.47 Not Significant Accepting Responsibility .37 P=.83 Not Significant Escape Avoidance 6.17 P=.04 Significant* Positive Reappraisal .91 P=.63 Not Significant Emotional Processing- Suppression .72 P=.70 Not Significant Signs of Unprocessed Emotion 8.87 P=.01 Significant* Unregulated Emotion 6.24 P=.04 Significant* Avoidance 6.00 P=.04 Significant* Impoverished Emotional Experiences 5.99 P=.04 Significant Total Emotional Processing Score 7.90 P=.02 Significant* Significant at .05 level of significance Table 2 (on further analysis with Mann-Whitney U) shows that the CH group differed significantly from CLBP group on Escape Avoidance Coping while on Planful Problem Solving Coping mechanism, significant difference was obtained between CH & CLBP as well as CH & NC groups. On further analysis with Mann- Whitney U the three groups significantly differed on Signs of Unprocessed Emotion subscale of Emotional Processing, CH & CLBP differed further on Unregulated Emotion, Impoverished Emotional Experiences and Total Emotional Processing component while CH & NC further differed on Avoidance, Impoverished Emotional Experiences as well as in terms of overall emotional processing.

108 Banerjee et.al. Variables Variables Coping-Self -Controlling Emotional Processing (EP) Signs of Unprocessed Emotion Total EP -.518* -.470* Coping-Accepting Responsibility Emotional Processing (EP)- Signs of Unprocessed Emotion EP-Unregulated Emotion Total EP .568** .537** .444* Coping-Escape Avoidance Signs of Unprocessed Emotion EP-Unregulated Emotion .461* .677* *Significant at .05 level of significance **Significant at .01 level of significance Table 3 Findings of correlation among the different variables within the Chronic Headache (CH) group Table 3 indicates that the Self Controlling subscale of Coping has a significant negative correlation with both Signs of Unprocessed Emotion subscale of Emotional Processing as well as total Emotional Processing (EP) score. The Accepting Responsibility subscale of Coping shows significant positive correlation with Signs of Unprocessed Emotion subscale of EP as well as with Unregulated Emotion subscale of EP and total score of EP. The Escape Avoidance subscale of Coping shows significant positive correlation with Signs of Unprocessed Emotion and Unregulated Emotion subscales of EP. Table 4 Findings of correlation among the different variables within the Chronic Low Back Pain group Variables Variables Coping-Distancing Emotional Processing- (EP)Impoverished Emotional Experiences .508* Coping-Self-Controlling EP-Unregulated Emotion Impoverished Emotional Experiences -.502* -.520* Coping-Seeking Social Support EP-Signs of Unprocessed Emotion .539* Coping-PlanfulPrpblemSolving EP-Unregulated Emotion Total EP Score -.620** -.837** Coping-Positive Reappraisal EP-Suppression EP-Impoverished Emotional Experiences .511* -.585* ·*Significant at .05 level of significance, **Significant at .01 level of significance Table 4 indicates that the Distancing subscale of coping has a significant positive correlation with Impoverished Emotional Experiences subscale of Emotional Processing (EP). The SC subscale of coping has a significant negative correlation with Unregulated Emotion and Impoverished Emotional Experiences subscales of Emotional Processing. The Seeking Social Support subscale of coping has a significant positive correlation with Signs of Unprocessed Emotion subscale of Emotional Processing. The Planful Problem Solving subscale of coping has a significant negative correlation with Unregulated Emotion and total score of Emotional Processing. Discussion: Among a host of psychological factors implicated in chronic pain, stressful events are thought to enhance or perpetuate pain, or reduce the individual's capacity to tolerate pain (Sternbach, 1974). Clinicians have pointed out that stressful experiences are commonly observable in the lives of many chronic pain patients and their viewpoints contributed toward early psychosomatic

Chronic back pain 109 theories (Engel,1959).The obtained findings for the Chronic Headache group point out that for these individuals the daily stressors that assume importance are personal issues (82%) which relate to decision making, meeting commitments, minor health issues etc. followed by environmental stressors like pollution, traffic, commuting etc. On the other hand the Chronic Low Back Pain (CLBP) group primarily experienced personal stressors (78%) followed by workplace related stressors (50%) like work load, meeting targets, work facilities etc. Research has pointed out that daily hassles are better predictive of psychological and somatic health outcome than life events (Chamberlain and Zike, 1990; Flannery, 1986; Kanneret al.,1981).The NUPRIN study (Sternbach, 1986) showed that individuals approached by telephone in the community reported a strong association between stress and pain in that minor ongoing stresses and strains of daily living – 'hassles' – were related to pain in different locations, including headache and backache. In their study Martin, Lae and Reece (2007) pointed out that stress may be considered as a trigger factor for headache. Several other studies have pointed out that migraine sufferers have increased sensitivity to stress (Huber and Heinvich, 2003; Drummond, 1985). Another study by Feuerstein et al.(1985) found environmental stressors such as family conflict and major life events to be more common among chronic low-back pain patients. In a prospective study of migraine headache sufferers, Holm, Lokken, and Myers (1997) found that prediction of migraines was dependent not just on “stress” but also on participant's appraisal of stress as threatening and whether resources were available to cope with the stress. The outcome of stressful events depends largely on our coping efforts. Coping is construed as efforts which help to prevent or, reduce threat, harm and loss or, helps in reduction of distress. In order to deal with their stress experiences the Chronic Headache group tend to use more of 'Self- Controlling' which refers to coping processes pertaining to efforts of the individual to regulate one's feelings and actions. They also use Positive Reappraisal which describes efforts of the individual to create positive meaning by focusing on personal growth which might also have a religious dimension closely followed by PlanfulProblem solving described as deliberate problem focused effort to alter the situation along with an analytic approach to solve the problem. They have also used Distancing to a certain extent which means that they employ cognitive means to detach themselves which rather minimizes the significance of the situation. Stanton and Snider (1993) found that patients of breast surgery who used cognitive avoidance were more distressed than those seeking social support. On the other hand the CLBP group have used Planful Problem Solving maximally followed by Confrontive Coping which are aggressive efforts to alter the situation and involves some degree of hostility and risk taking behaviour. A study conducted by Vollrath,et al., (1996) pointed out that venting of emotions is considered as a negative predictor of mental health. This also finds support from a previous study conducted by Vollrath,et.al. (1994) which found that venting emotions was related to most of the clinical syndromes of MCMI-II. The present study didn't reveal any significant difference between the groups on the different coping scales except for Escape Avoidance (wishful thinking and behavioural efforts to escape or avoid the problem) and Planful Problem Solving which differed in the CH and CLBP groups. Avoidance is a form of coping associated with maladaptive outcomes like higher levels of physical and psychological symptoms (Aldwin and Revenson,1987). Avoidance coping has been found to be related most consistently to different symptoms of mental disorders. Studies have demonstrated that this holds true for patients with psychiatric problems (Billings and Moos, 1984; Borden et al., 1988; Kleinke, 1988; Vitaliano et al.,1990; Vollrath, Alnæs, &Torgersen, 1994a; Vollrath et al., 1994b), as well as for patients with physical health problems (Kleinke, 1988, 1992). Bombadieret al.(1990) found that the emotional coping styles of wishful thinking, self-blame, and avoidance were associated with poor adjustment to chronic illness. Although most studies have pointed out that active problem focused coping is beneficial, some studies demonstrated contrasting results. Hoffart and Martinsen (1993), however, found that problem-focused coping influenced neither depression nor anxiety. Studies have demonstrated that active attempts at problem solving work best for controllable stressors but become harmful in the context of uncontrollable stressors (Alridgeand Roesch, 2007; Clarke, 2006) for which emotion focused coping such as self-regulation

110 Banerjee et.al. etc. predicts superior outcomes (Austenfeldand Stanton, 2004). Folkman and Lazarus (1980) found that work related stressors were associated with increased problem-focused coping while illness related stressors were associated with increased emotion focused coping. Early studies related to psychosomatic medicine have pointed out that chronic pain problems were often attributed to various conflicts or to defences against emotional experiences (Engel,1959). However contemporary stress theory and research have pointed out that the effects of stressful experiences and inner conflicts are mediated by one's emotional processing of the event (Borkovec, et al., 1995; Pennebaker,1993). As far as emotional processing is concerned, it seems that CH group showed greater deficits in comparison to the CLBP group. Except for the subscale Suppression in which the Normal group showed maximum deficits, the CH group displayed greater emotional processing deficits in general as well as greater deficits in the various domains of emotional processing. Emotional processing is a process whereby emotional disturbances are absorbed and decline to the extent that other experiences and behaviour can proceed without disruption (Rachman,1980). If emotional disturbances are not processed completely, then signs of this will emerge in the form of intrusions, over arousal, agitation, rumination, avoidance etc. The Chronic Headache group seems to have difficulties in emotional processing in general and tends to use more of Avoidance in particular followed by Signs of Unprocessed Emotion. The CLBP group have used Suppression maximally although that has been significantly less than the other two groups closely followed by Avoidance. The two groups have differed from each other in terms of intrusive and persistent emotional experiences (Signs of Unprocessed Emotion), displaying an inability to control emotions (Unregulated Emotion), as well as suffering from impoverished emotional experiences (Impoverished Emotional Experiences) like being detached, unpleasant, confused along with vague attributions. Research findings have consistently pointed out to the fact that deficits in emotional processing are associated with psychopathology. The resultant condition is an increase in rumination, avoidance and maladaptive coping in general in mental health problems (Gross, 1998; Gross and Munoz, 1995); decrease in perception, understanding and expression of one's affective experience in depression and anxiety specifically (Luminet et al. 2001). Carson et al. (2007) found that greater ambivalence over emotional expression was related to higher evaluative and affective pain in patients with persistent low back pain. Conclusion: The study thus revealed that maximum stressors were experienced by the Chronic Low Back Pain group in the domain of personal stressors along with work place stressors while the Chronic Headache group experienced more of personal stressors. The Chronic Headache group tended to use more of escape avoidance coping i.e. wishful thinking along with behavioural efforts to avoid the problem, experienced intrusive and persistent emotional experiences as well as suffered from impoverished emotional experiences like being detached, unpleasant, confused along with vague attributions. The Chronic Low Back Pain group, on the other hand, used more of Planful Problem Solving followed by Confrontive Coping i.e. aggressive efforts to alter the situation, which however has been accompanied by excessive control of emotional experiences. References: Aldridge, A.A. and Roesch S.C. (2007). Coping and adjustment in children with cancer: a meta-analytic study. Journal of Behavioural Medicine,30,115–129 and Austenfeld, J.L. and Stanton, A.L. (2004). Coping through emotional approach: a new look at emotion, coping, and health-related outcomes. Journal of. Personality, 72,1335–1363 Baker, R. (2001). An emotional processing model for counselling and psychotherapy, a way forward? Counselling in Practice, 7 (1), 8-11. Baker, R., Thomas, S., Thomas, P.W. and Owens, M. (2007). Development of an emotional processing scale. Journal of Psychosomatic Research, 62, 167-178. Basu, S. (2005).Development of Daily Hassles Checklist. In Glimpses into Behavioural Science: Methods and Themes into Practice. Edited by Basu J. and Gupta H. N.: UGC Academic Staff College and Applied Psy., Calcutta University; 2005: 42-49 and Aldwin, C.M., Revenson, T.A. (1987). Does coping help? A reexamination of the relation between coping and mental health. Journal of Personality and Social Psychology, 53, 337–348. Billings, A.G., Moos, R.H. (1984).Coping, stress and social resources among adults with unipolar depression. Journal of

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physical health, work, and family problems. Health Psychology, 9, 348–376. (2), 125–135. Vollrath, M., Alnaes,R. and Torgersen, S.(1994). Coping and MCMI- II personality disorders.J.Personality Disorders, 8(1), 53-63. Vollrath, M., Alnaes, R. and Torgersen, S. (1996). Differential effects of coping in mental disorders : A prospective study in psychiatric outpatients. Journal of Clinical Psychology, Vollrath, M., Alnæs, R. Torgersen, S. (1994a). Coping and MCMI- II personality disorders.J.Personality Disorders, 8, 53– 64. Vollrath, M.,Alnæs, R. Torgersen, S. (1994b). Coping and MCMI- II symptom scales. J.Clinical Psycho. 50, 727–736. Watkins, E.A., Wollan, P.C., Melton, L.J. Yawn, B.P. (2008). A population in pain: report from the Olmsted County Health Study. Pain Medicine, 9, 166-174. and and and 112 Banerjee et.al. SOMATIC INKBLOT SOCIETY IS PUBLISHING ITS JOURNAL SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH a half yearly publication in January and July. It started in 1994 and has published 40 issues in 20 years. The Journal is available on Society's Web Site at http: //www.somaticinkblots.com The Journal from Volume 1-21 is available in (Acrobat ) Members of Somatic Inkblot Society can get the soft copies of all issues on a nominal payment ofUS $50 (for Overseas Members) and Rs.1500/- (for Indian Members). The Individual and Institutional Life Members of Somatic Inkblot Society/SIS Journal Can get the current issue and future issues of the Journal through Electronic mail free of charge Please indicate if you wish to get the soft copy of the Journal through Electronic mail To: Bankey L. Dubey, Ph.D., DPM, DM&SP, Editor Emeritus, SIS J. of Proj. Psy. & Mental Health, E-mail : bldubey@gmail.com

interpretation (Hunsley& Baitley,1999;Wood et.al ,2001), evidence confirms that if scoring criteria are constructed carefully and validated properly, freeresponse tests and especially inkblot tests can provide highly valuable, valid and reliable information regarding an individual's cognitions, and coping structure ( Bornstein and Masling, 2005; Huprich,2006; Viglione,1999; Weiner, 2000). Despite controversies and criticisms, the inkblot tests have been most extensively used, still being used and have contributed significantly in personality and motivational assessments, diagnostic process and therapeutic intervention. There are three major standardized tests based on inkblots. The first pioneer amongst these is Rorschach Inkblot Test (RIT), published in 1921, that has dominated the field of psycho-diagnosis. The second is Holtzman Inkblot Technique (HIT), developed by Holtzman (1956), overcoming some of the limitations of RIT by adding the psychometric properties and standardized procedures of scoring and interpretation.HIT represents a genuine attempt to meet the technical standards of psychometric instruments in its original development (Holtzman,1968,1975; Holtzman et.al, 1961).The changes in the stimulus material procedure are sufficiently extensive in comparison to RIT. Administration and scoring of HIT are wellstandardized and clearly described. It is scorable for 22 variables, and for each variable, percentile scores are reported for several normal samples, ranging from 5- year-olds to adults, and for a number of deviant groups including schizophrenics, mental retardates, emotionally disturbed, delinquents, & alcoholics ( Hull, 1972). The third is the Somatic Inkblot Series(SIS), developed by Cassell , (1964) and Cassell and Dubey (2003) as an extension and advancement of inkblot techniques overcoming the inherent limitations of traditional inkblot tests. It has been developed primarily to understand the manifestation of problems through somatization and to hear the inner cry of an individual, and is based on three theoretical postulates, i.e., Somatic Imagery, Body symbolism, and Inner cry. Somatic Imagery theory proposes that every individual has a unique and highly personalized system of attitudes, both conscious and unconscious, that is projected onto the body concept as a special entity. These interact with feedback sources and internal sensations. Discrete mental representations exist for particular somatic regions, which continuously complete for full registration in consciousness. Somatic awareness increases in some psycho-physiological states such as hunger, exertion, emotional arousal and sexual excitement. Consequently, mental representations in the body fade in to the background of consciousness. Body symbolism refers to a mental process in which an individual manifests the somatic concerns or problems symbolically through imagined percepts in inkblots. For example, an organic or functional disorder in any organ or system may be expressed through anatomical responses (Rorschach, 1951).Body symbolism contends that an individual integrates mental and physical phenomena, and is based on the old philosophy principle of mind-body relationship. The inner cry for help model

proposes that emotional volcano buried into the unconscious due to childhood abuses, traumatic experiences, frustrations and emotional turmoil can be erupted in the form of somatic percepts in inkblots or images of SIS. Hence, inner cry model propagates that expressed somatic responses to inkblot images are translation of pent up emotions in mental reservoir of the unconscious. SIS provides inkblot images in three forms: (1) SIS-I (Card Form: 20 cards), (2) SIS-II (Booklet Form: 62 images), and (3) SIS- Video (SIS-I video; SIS II video/CD).SIS-I consists of 20 inkblot images printed on white cards in black, red, and gray. It can be used for the assessment of depth and significance of somatic symptoms, conversion reactions, somatic symptoms, somatic delusions, sexual dysfunctions, castration anxiety, body assault and aggressive impulses. SIS-II consists of 62 images divided in A and B series printed with blue ink on gray paper. It can be used in several ways but is basically designed for self- administration. It is scorable in terms of eleven scales i.e. Total No. of Responses (R), Human Response ( H), Animal response ( A), Anatomical responses ( At), Sex Response (Sex), Movement responses ( M), Most Typical response ( MT) , Typical responses ( T), Atypical responses ( AT), Rejection ( Rej), and Pathological Responses – (a) Pathological anatomy (PAS), Depression ( D), Hostility & Aggression (HAS) and Paranoia ( P).Obtained protocols can be interpreted in terms of content analysis and quantitative analysis. All the required psychometric properties have been established. With the advent of video technology SIS-I video and SIS-II video (Cassell & Dubey, 2003) have also attracted researchers widely. Review of literature on SIS reveals that SIS- II (Booklet Form) has attracted more researchers followed by the SIS-I card form. It maybe because it consists of more images (62) to cover more somatic symptoms than the card form (SIS-I) which consists only 20 images. SIS- II has been used on a variety of clinical samples, some of them being, psychotics & neurotics (Rathee et al, 1995, 2002), schizophrenia and depressives ( Prashad&Verma, 1995), murderers ( Singh et.al, 2000), ADHD ( Jain et al., 2005), CHD ( Dubey et al, 1994), obesity ( Cinzia& Roberto, 1998), mania ( Kumar et al, 2005, 2006), violence ( Cassell & Dubey ,2006), suicide ( Cassell , 2006;Singh & Rani, 2014), PTSD ( Cassell 2006), police personnel problems (Dubey & Dubey, 2005). Review of literature also reveals that most of the studies on SIS have been conducted in clinical setting, primarily to compare the clinical groups against normal subjects. But inkblot technique can also be useful for the assessment of personality and other aspects of normal behavior and psychological processes. The present study intends to examine the effect of age and education on SIS-II percepts. Method: Two groups of female students of 11th and 12th grade, ranging in age from 16 to 18 years, were randomly selected from various schools of Haryana after obtaining due consent from the students and permission from respective principals. Likewise, 120 female PG students were selected from PG Departments of Kurukshetra University, Kurukshetra ranging in age from 21 to 25 years with the mean age of 23 years. The sample was reconstructed with respect to urban areas and middle class family status. Measures: 1. Background information about the participants was obtained through a personal data sheet designed for the present study to ascertain the urban domicile and similarly of socio-cultural background of the participants. 2. SIS- II (Booklet form.) Results and Discussion: Descriptive statistics (mean, standard deviation) and t- ratios were computed to compare the two groups' in terms of significance of mean differences which are reported in Table 1. Perusal of table 1 reveals that there are significant differences in the school students and PG students with regard to some SIS-II percepts. It can be noted from Table–I that female PG students have scored significantly lower on Total number of Responses ( R), Animal Responses; and higher on Atypical, Sex, Movement, Most Typical ,Typical, Atypical, Rejection, Pathological Anatomy, Depression, Hostility- Aggression, and Paranoia scales of SIS-II than school female students. 114 Verma & Singh

Table 1 Effect of Age on SIS 115 Variables PG students (N=120) mean PG students' SD School Students (N=150), Mean School students' SD t R 60.16 2.60 60.82 1.83 -2.365 H 19.54 4.72 19.19 4.49 .619 A 9.28 5.05 10.61 3.53 -2.458 At 13.86 5.20 10.55 3.58 5.942 Sex 2.82 2.60 .97 1.21 7.201 M 17.46 6.65 6.91 4.34 15.028 MT 10.65 2.55 9.08 2.34 5.219 T 25.37 7.10 11.45 3.72 12.03 AT 4.56 2.92 2.37 1.81 7.189 Rej 1.87 2.60 1.15 1.81 2.857 PAS 5.94 3.29 .74 1.30 16.326 D 6.38 4.99 4.86 2.95 2.853 HAS 7.48 4.23 3.27 2.25 9.868 P 1.76 1.21 .95 1.28 5.328 Total No. of Responses: Total No. of Responses were significantly lower among PG students as compared to school students. Cassell and Dubey (2003) have concluded that total number of responses are indicative of productivity. When a person is presented with unstructured or semi-structured stimuli-like images of SIS-II, a person is required to organize either the entire inkblot or elect a portion of it to make meaningful associations in terms of past experiences that generate enough cognitive loads on the individual. In childhood or adolescence the imagery is more spontaneous and eidetic because of few past experiences. With maturity and advancing age, an individual's imagination and thinking is more influenced by socio-cultural acquisitions which interfere in the spontaneous imagination and suppress the recall of associations related to negative affect, frustrations, and conflicts. Hence, the cortical inhibition developed through the repressive socio-cultural introjections may be the reasons of selective responding to the inkblots. It is also clear from the fact that PG students have rejected more number of inkblot images of SIS-II that are indicative of emotional blockage and low level of stress tolerance. Hence, significantly low level of total number of responses among PG students is understandable in terms of psychoanalytic concepts of repression and suppression which increase with maturity and advancing age because of more influence of sociocultural expectations, internalizations and introjections. Human Responses: In case of score on the scale of Human Responses, the two groups have not differed significantly. Animal Responses: PG students have scored significantly low on animal response scale than their counterpart school students. Animal responses in inkblots are considered to be indicative of interactional comfortability with animals and psychological immaturity (Cassell & Dubey, 2003; Holtzman et.al., 1961). It may be because of low level of fears in younger age as a result of low level of knowledge about the negative consequences of interactions with animals. Hence, low mean score on the scale of animal responses depicts the P.G. students to be more psychologically mature than their counterpart school students. Anatomical Responses: PG students have scored significantly high on SIS-II scale of anatomical responses. High scores on anatomy in inkblot tests are considered to be reflective of poor self –image and preoccupation with internal body organs (Cassell & Dubey, 2003).In SIS –II because the anatomical structures are embedded in the inkblots, so it

116 Verma & Singh is well expected for the PG students scoring high because of high level of literacy about the anatomy, structural and functional organizations of the body as a whole as well as its systems and organs. Another reason for it may be somatic hypersensitivity, somatization, body image dysphoria, appearance anxiety, and figure consciousness prevailing more in young adults who are at the threshold of entering into married life as implicit motivation of having attractive body figures. Sex Responses: On sex response scale of SIS-II also PG students have scored significantly higher than school students. High score on sex response scale of any inkblot test is considered to be indicative of latent erotic need & sexual anxiety; and very high scores are considered indicants of sexual dysfunctions. Since, all the female PG students were unmarried, so their higher scores on sex scale can be taken as representative of their implicit sexual urges and psychological preparedness for entering into the married life which provides the gratification to the sexual needs in socially approved manner. Movement: Movement responses in inkblot tests are considered as indicative of internalization and ability to handle more deliberate and sophisticated experiences in emotionally controlled way (Rorschach ,1942), awareness towards the external world and reflective of some unexpressed conflicts and emotions in the realistic world (Beck,1944), motoric expression of affect (Werner,1948), and implicit potential for dynamic energy (Holtzman et.al,1961).Here, the high level of movement responses in PG students than school students are well understandable in the light of above mentioned assertions that PG students or young adults have multiple goals, aspirations, goal orientations and consequently multiple conflicts with which they are able to cope, maintaining psychological and behavioral harmony with impelling, imposing and restrictive sociocultural settings. Most Typical Responses: On the scale of Most Typical Responses also, PG students have scored significantly higher than school students. Most typical responses are indicative of coherent, logical thinking, ego strength team concept, and group conformity (Cassell & Dubey, 2003).In prediction of Most Typical responses to inkblots, higher cognitive process is involved i.e. the individual scans the image and then either selects the complete image or isolates a portion of the blot area and produces the responses. High scores of PG students over school students are well understandable in the light of their socio-cultural and academic maturity that they acquire across the age through socialization and academic exposure. Young adults become comparatively more mature psychologically, socially, culturally and academically than school students. Typical Response: PG students have scored significantly high on the scale of Typical responses than school students. Typical responses are scored when an individual produces shape-appropriate percepts to the identified blot area; and are indicative of reality testing and healthy perception (Cassell & Dubey,2003). In the production of typical responses, an individual scans the inkblot image and then selects either the complete image or isolates a portion of blot area for the percepts based on recollection of past mental images from the unconsciousness resembling the blot area. High scores on the scale of typical responses by P.G. students are well understandable in terms of wide experiences of young adults through more cognitive, affective and psychosocial maturity as compared to those of adolescents because adolescents' perceptions,& thinking are dominantly regulated b y emotions. Hence, the present finding depicts young adults characterized by high level of healthy perceptions and reality testing. A typical Response: On Atypical Response scale also, PG students have scored significantly higher than the school students. Atypical responses are polar opposite of the typical responses; and are scored when the shape of perceived percept does not match to the identified blot area. Atypical responses in clinical groups are indicative of impairment in reality testing but in normal subjects these in good form are reflective of intelligence and creative imagination. Literature also reports increase in creative thoughts with age and maturity in young adulthood. Hence, the present finding also depicts that intellectual and creative imagination increase with cognitive and

Effect of Age on SIS 117 academic maturity acquired with age increment Rejection of Images: P.G. students have scored significantly high on rejection of inkblot images than their counterpart school students. Rejection of images in SIS-II is considered to be indicative of thought blockage, conflictual thinking, and low stress tolerance. When presented with an unstructured or semi-structured stimulus, a person is required to organize the entire inkblot or extract a portion of it to make meaningful associations, hence there is enough cognitive load on the individual. At times, an image of inkblot is linked to negative psychological experiences of an individual and it activates the conflict which becomes overwhelming and consequently the image gets rejected. Rejected images are diagnostically important to the clinician as those represent the unlocked inner cry of the subject. Rejections depict an individual's tendency to shut out the cognitive processes in the face of stress, conflict and implicit cognitive load. As compared to school students (adolescents), young adults (PG students) have more probabilities of image rejection because multifaceted conflicts and stresses are encountered with increased age, psychosocial and academic maturity. Moreover, they tend to have more varied dynamic and goal conflicts than school students. Pathological Anatomical Responses: PG students have scored significantly high on the scale of pathological anatomical responses that school students. Pathological anatomical responses are indicative of excessive personal health concern, pathological identification with decreased anatomy and hypochondriacal tendency. Young adults, particularly females, tend to be more sensitive and conscious of their appearance and body image because of repeated comparison with more healthy persons and film actresses of their identification, body image dysphoria and appearance anxiety. Literature in this regard also reveals the high level of body image dysphoria and appearance anxiety among young adults and adults than among adolescents. Hence, the present findings depict young adult females to be hypersensitive to their health, body image and appearance than adolescent females (school students). Depression: The significantly high scores on the scale of depression by young adults (PG students) than school students are well understandable in terms of high level of psychosocial and academic maturity. Young adults who participated in the present study were in the process of completion of their studies after which they are to enter into the realistic world. By this time they have encountered more stressors, frustrations, unfulfilled expectations and goals, and negative experiences which are forerunners of their helplessness and depression. Literature on developmental processes also reveals that adolescence period is dominantly characterized by euphoria and adulthood by helplessness, negative experiences and hence results in depression. Hostility Aggression: Statistically significant higher scores by PG students than school students on the SIS-II scales of HAS depicts them to be having high level of hostile attitudes, aggressive conflicts, and hostile impulses. More hostility aggressive percepts among young adults are understandable in terms of developmental processes. Hostile and aggressive behaviors are usually the reactions to frustrations, conflicts, coping features. PG students in their young adulthood period are more in encounter with varied frustrations, conflicts, multiplicity of goals and aspirations and consequently have more opportunities of coping failures, hence consequently are more prone to have hostile attitudes, aggressive impulses and conflicts than school students. Paranoia: On this scale significantly high score by PG students than school students depicts pre-ponderance of paranoid ideation among them. Clinical literature reveals that delusional ideation is positively related to negative experiences one had in one's life. PG students being senior in age and maturity have encountered more negative experiences and frustrations than school students; so, it is justified to be high on paranoid ideation, threat sensitivity, and exaggerated sense of self –consciousness than adolescents (school students). Conclusion: The findings of the present study depict the potential of

SIS-II to index the differential effect of age and education on the thinking, imagination, and perception of adolescents and young adults. Overall, findings of the present study depict young adults to be more characterized by cortical inhibition, zoo fears, body image dysphoria, appearance anxiety, sexual anxiety, psychodynamic energy, social conformity, healthy perception, creative imagination, low stress tolerance, hypochondriatic tendency, over health concern, depressed mood, hostile & aggressive impulses & conflicts, and exaggerated sense of self –consciousness. The results of this study though reflect significant age and educational differences in SIS-II percepts yet can't be considered generalized. Large scale studies on samples of different age groups are required and suggested for obtaining more generalized findings. References: Beck, S.J. (1944). Rorschach Test Process,Vol.1.New York: Greene & Stratton. Bornstein,R.F. (2007) Might the Rorschach be a projective test after all? Social projection of an undesired trait alters Rorschach Oral Dependency scores. Journal of Personality Assessment, 88,354-367. Cassell, W.A and Dubey, B.L. (2003).Interpreting Inner World through Somatic Imagery: Manual of the Somatic Inkblot. Series.Anchorage Somatic Inkblot Centre. 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. Cassell, W.A. (1964).A Projective Index of Body Interior Awareness. Psychosomatic Medicine, 26:172-177. Cassell, W.A. (2006) SIS Cognitive Psychotherapy for Spouse Induced PTSD. SIS Journal of Projective Psychology & Mental Health, 13 (1), 25-36. 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. 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. 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. 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. Hunsley, J. & Bailey, J.M. (1999). The clinical utility of the Rorschach: unfulfilled promises and an uncertain future. Psychological Assessment, 11,266-277. Huprich, S.K. & (Ed.) (2006). Rorschach assessment of the personality disorders. Mahwah, NJ: Lawrence Erlbaum Associates. Jain, R., Singh, B. Mohanty, S.R. and Kumar, R. (2005). SIS- I and Rorschach Diagnostic of Content Analysis of SIS-II.SIS Journal of Projective Psychology & Mental Health, 12(2):141- 152. Kumar, D., Kumar, J. and Kumar, R. (2005). Diagnostic Indicators on SIS-I and Rorschach Among Manic and Depressive Patients, SIS Journal of Projective Psychology & Mental Health, 12(1):53-60. 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. McClelland, D.C., Koestner, R., & Weinberger, J (1989).How do selfattributed and implicit motives differ? Psychological Review, 96, 690-702. Prashad, D., and Verma, S.K.(1995). Diagnostic Significances 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 Significance of content Analysis of SIS- II. SIS Journal of Projective Psychology & Mental Health, 13, 61-64. Rorschach, H. (1921) Psychodiagnostik. Berne: Huber. Singh, A.R., Dubey , B.L., Sahu, L.M., and Banarjee, K.R. (2000).SIS- II Profile of Murderers. SIS Journal of Projective Psychology & Mental Health. Vigilione, D.J. (1999). A review of recent research addressing the utility of the Rorschach. Psychological Assessment, 11, 251- 265. Weiner, I.B. (2000). Using the Rorschach properly in practice and research. Journal of Clinical Psychology, 56, 435-438. Werner, H.(1948).Comparative Psychology of Mental Development. Chicago, Follett. Wood, J.M., Lilienfeld, S.O., Nezworski, T.M., & Garb, H.N. (2001). Coming to grips with negative evidence for the comprehensive system for the Rorschach: a comment on Gocano, Loving and Bodholdt, Ganellen, and Bornstein. Journal of Personality Assessment, 77, 48-70. Singh, U., & Rani, K. (2014).SIS-II Correlates of Suicide Ideation among Adolescents. SIS Journal of Projective Psychology & Mental Health, 21(1). 118 Verma & Singh

RBCs transfusion frequently to stay healthy and to survive. India accounts for 10% of the total world thalassemia population and approximately 1 in 30 persons in the general population is carrier of this disease. It is non- infectious and inherited from parents in an autosomal recessive pattern (Weatheralland Clgg, 2001). SIS-II test has been used internationally on varieties of clinical population and found a successful for personality assessment (Cassell and Dubey, 1990).It has been used on normal, neurotics, psychotics and other population by several researchers (Dubey, et al., 1993, 1994; Rathee et al., 2002; Kumari et al., 2009; Tiwari et al., 2012), medical practitioners (Sarika, et al., 2009) and epileptic patients (Mishra et al., 2010) etc. The latest study shows that psychological problems are more comorbid with thalassemia patients and need to address psychosocial aspects in the overall treatment of such patients (Jain et al., 2013). Chronic nature of thalassemia and its intensive and demanding treatment result in significant psychological burden on the patients. The present study was planned to analyze the psychological aspects of personality of the thalassemia patients by using Somatic Inkblot Series -a projective inkblot test. Methodology: Sample: Thirty thalassemia patients and thirty normal subjects were taken for the study. It was a purposive Sampling.The Mean age of thalassemia patients was 15.73 ± 5.12 years and normal subject was 17.43 ± 3.15 years. Both the groups were matched on age and sex. There were 15 male and 15 female in each groups. The Thalassemia patients were taken from Thalassemia Control Unit of Malda Medical College & Hospital, Malda, (WB). Tools: General Health Questionnaire-12 (Goldberg & Hiller, 1979): The shorter version of the GHQ-12 has been used to screening the presence of any clinical conditions in normal participants. Somatic Inkblot Series (SIS)-II(Cassell & Dubey, 1990, 2003): It consists of 62 images (31 each in Series 'A' and 'B'. It has been used successfully to identify various groups of clinical subjects from normal subjects. Procedure: Thirty Patients attending Thalassemia Control Unit of Malda Medical College & Hospital, Malda, (India) and 30 normal participants were taken for the study. The thalassemia patients were diagnosed by High Performance Liquid Chromatography (HPLC) Test. The patients who had periodic blood transfusion were included in the study. The Normal subjects were selected if they obtained scores 2 and below on the GHQ-12. Finally, the SIS-II test was administered to each participant individually. The protocols were scored and the data was analyzed by using Mean (M) SD and Chisquare.

Results and Discussion: The participants in both the groups matched for age and sex. Sixty three percent participants had low education (below 5th class) with more number of Muslims(60%) in thalassemia group. Table 1 indicates that thalassemia patients scored significantly lower than normal participants on total number of responses, human responses, sex responses, movement responses, most typical responses and typical responses. However, score of thalassemia patients was higher in comparison to normal participants on animal responses, pathological anatomy scale, depression and hostile & aggression. Significantly low number of responses in thalassemia patients (61.73 ± 2.32) as compared to normal participants (63.63 ± 3.37) indicates their low productivity, low imaginative ability and functional intelligence.Human responses in both the groups were within normal range indicating their smooth interpersonal relationship. Table 1 Responses of thalassemia patients and normal participants on SIS-II indices SIS-II Indices Thalassemia(N = 30) Normal Control(N = 30) t-value (df = 58) Mean SD Range Mean SD Range Total no. of Responses (R) 61.73 2.32 55.0-67.0 63.63 3.37 58.0-75.0 2.54* Human Responses (H) 21.20 3.11 18.0-33.0 23.33 3.46 19.0-29.0 2.51* Animal Responses (A) 13.40 4.45 3.0-21.0 9.37 4.84 3.0-22.0 3.36** Anatomical Responses (A) 13.40 5.48 5.0-32.0 13.10 7.01 4.0-24.0 0.18 Sex Responses (Sex) 1.03 0.92 0.0-3.0 2.23 1.30 0.0-6.0 4.10** Movement Responses (M) 3.40 2.12 0.0-8.0 6.57 4.41 0.0-14.0 3.54** Most Typical Responses (MT) 9.50 2.22 4.0-13.0 13.30 1.82 9.0-14.0 7.24** Typical Responses (T) 24.97 3.12 18.0-33.0 30.17 2.27 21.0-38.0 7.37** Pathological Anatomy Scale (PAS) 0.67 0.76 0.0-2.0 0.27 0.45 0.0-1.0 2.48* Depression 0.80 0.80 0.0-3.0 0.40 0.50 0.0-2.0 2.31* Hostile & Aggression 2.13 0.86 0.0-3.0 1.23 0.97 0.0-3.0 3.80** Paranoia 0.07 0.25 0.0-1.0 0.00 0.00 0.0-0.0 1.44 Rejection of Images 1.40 1.99 0.0-0.8 0.63 1.22 0.0-0.5 1.80 *p<.05; **p<.01, Significantly higher number of Animal response (13.40 ± 4.45),by patients may indicate their aggressive attitude, frustrated ambitions and inability to cope with situation in life. The patients have shown difficulty to retain controlled reaction under frustration and stressful situation than normal participants(9.37 ± 4.84).It may also indicate immaturity in the thalassemia patients. Both the groups have perceived fairly large number of Anatomical responses which may indicate awareness with body organs along with bodily anxiety in patient's group. Normally, except medical and physiology students, others do not perceive more than 15 percent of anatomical responses. The low number of Sex responses (1.03 ± 0.92) with low number of Movement responses (3.40 ± 2.12) by Thalassemia patients may indicate their passive mood and depressive feelings. It could also be due to frustrating situation in life and withdrawal from social interaction.The significantly low Movement responses in patient's group (3.40 ± 2.12) than normal participants (6.57 ± 4.41) may further indicate their inability to face difficulty in life and utilize available resources to cope up with the demand of the situation. 120 Bhogta et.al.

Significantly low number of Most-Typical responses (MT) in thalassemia (9.50 ± 2.22) than normal participants (13.30 ± 1.82) indicates poor adaptive ability, withdrawal from reality and inability to keep up with the demands of society, weak ego strength and very low organizing capacity. Such low MT responses are often seen in borderline neurotic patients who have difficulty in adjustment. Hostility and aggression responses were comparatively higher in thalassemia than normal participants, indicate their aggressive and hostile attitude, and might be due to their frustrating life situation. They have also rejected more number of projective images which may indicate inner conflict and unprocessed painful material which can be addressed during psychotherapeutic session. Other responses such as Typical, Depression, Paranoia were found within normal range. Conclusion: Analysis of present study reveals that thalassemia patients scored significantly lower than normal participants on total number of responses, human responses, sex responses, movement responses, most typical responses and typical responses. However, thalassemia patients scored higher on animal responses, and hostile and aggression as compared to normal participants. The Thalassemia patient were found to be aggressive and hostile, inactive, passive mood, withdrawal from social interaction, low productivity, inner conflict and unprocessed painful material in need of redressed. The sample is too small to have such important conclusion. References: Alreja, S., Mishra, D.K., Sengar, K.S., Singh, A.R. and Chaudhury, S. (2009). SIS-II Profile of Medical Practitioners. SIS Journal of Projective Psychology & Mental Health, 16, 2: 178-179. Cassell, W.A. (1990). Somatic Inkblot Series (SIS-II) Booklet Form, SIS Center, Anchorage,(USA). Cassell, W.A., and Dubey, B.L. (2003). Interpreting Inner World through Somatic Imagery, SIS Center, Anchorage,(USA). Dubey, B.L. and Cassell, W.A. (1993).Some Experience with Somatic Inkblot Series-II. British J. Projective Psychology, 38, 1: 19-41. Dubey, B.L., Mishra, M., Dwivedi, C.B. and Mishra, N. (1994).Diagnostic and Therapeutic Utility of SIS-II and Rorschach. SIS Journal of Projective Psychology & Mental Health, 1: 19-26. Goldberg, D.P., and Hiller, V.F. (1979).A Scaled Version of the General Health Questionnaire. Psychological Medicine, 9: 139-145. Jain, M., Bagul A.S., &Porwal, A. (2013).A Psychosocial Problems in Thalassaemic Adolescents and Young Adults. Chronicles of Young Scientists, 4: 21-3. Kumari, D., Prakash, J., Singh, A.R. and Chaudhury, S. (2009). Personality Profile of Schizophrenia and Bipolar Affective Disorder (Mania) on SIS-II. SIS Journal of Projective Psychology & Mental Health, 16, 2: 138-146. Mishra, D.K., Alreja, S., Jahan, M. and Singh, A.R. (2010). SIS-II Profile of Epileptic Patients. SIS Journal of Projective Psychology & Mental Health, 17, 2: 187-191. Rathee, S.P., Pardal, P.K. and John, T.R. (2002).Diagnostic value of SIS-II among Sub-groups of Psychotic and Neurotic Patients of Armed Forces. SIS Journal of Projective Psychology and Mental Health, 9, 1: 23-32. Tiwari, A., Pandey, P., Mishra, A. and Dubey, A. (2012).SIS-II Profile of Depressive Patients. SIS Journal of Projective Psychology & Mental Health, 19, 1: 48-55. WeatherallD.J.and Clegg J.B. (2001). The Thalassaemia th Syndromes.4 ed. Oxford: Blackwell Scientific Publications. SIS in Thalassemia 121

"SIS SOCIETY HONOR ROLE": "Throughout history human unbridled aggression worldwide has led to seemingly ceaseless oscillations between peace and war. With the advent of weapons of mass destruction, civilized life on planet earth now exists in an evermore precarious state. It is essential that Society members develop SIS assessment applications for screening all individuals having access to such weapons. Our profession needs to reach out and provide consultative services for the police, military and all government agencies concerned with preventing such aggression. This is a serious problem that seemingly can only be solved by "Preventative Treatment". After the fact of nuclear world war, it is likely that "Treatment" theoretical models would have little relevance. In this issue of the journal a "SIS Honor Role" will be initiated. Its goal will be to recognize as spiritual mentors those who have already played an important preventative role. We are initially focusing on all those brave individuals who prevented Adolph Hitler from accessing Norwegian heavy water supplies produced in an industrial plant at Vermont.This deranged dictator's engineers came very close to successfully assembling nuclear weapons, more so than most people generally recognize. World War II would have ended much differently, if it were not for the efforts of heroic Norwegians who initially destroyed the production facility and then sank a ship transporting the last supply of heavy water. One of the heroic soldiers photograph is shown here.(An interested reader may find related detailed historical data by inserting "The Norwegian Heavy Water Sabotage" into Wikipedia.). All of us can benefit from psychological identification with positive heroic mentors - especially those in training and younger members of our SIS Society In association with the above "SIS HONOR ROLE" the Somatic Inkblot Society will award $500.00 for a leading SIS article on the roots and management of aggression. Wilfred A Cassell, M.D., APC, FAPA, Editor Emeritus SIS J. Proj. Psy & Mental Health E-Mail: siswilfredacassell@yahoo.com

THE SOMATIC INKBLOT SOCIETY I wish to be a Life Member ___________________________of the Somatic InkblotSociety. Please submit this request to the Membership Committee. NAME _______________________________________________________Birth date ___________________ Mailing Address : __________________________________________________________________________ ___________________________Tel. : (W)______________________________H)______________________ EDUCATION Degree Year Institution Major Field of Study EMPLOYMENT : Current position, employer, dates (Graduate Students indicate area of study and degree toward which you are working). MEMBERSHIP : __________________________________________________________________________ TRAINING AND EXPERIENCE IN PERSONALITY ASSESSMENT : SPONSOR (S) Name Address Telephone 1._______________________________________________________________________________________ 2._______________________________________________________________________________________ SIS subscription payable every year in January through Cheque /Bank transfer to Punjab National Bank, in the SIS Journal's account given below: Name of Account: SIS Journal of Projective Psychology & Mental Health Bank Name: Punjab National Bank, Bhikharipur Branch, DLW-Kakarmatta Road, Varanasi -221004 Account No. 4045000102207342, (IFS Code: PUNB0404500) Subscription can also be made thru cheque, in favor of “SIS Journal of Projective Psychology & Mental Health” and mail to Editor in Chief's address at Varanasi. Annual membership fees are US $50 for foreign members and Rs. 1000, for Indian members. Institutional subscriptions are US $100 for Foreign institutions and Rs.1500 for Indian institutions. Life membership is US $300 for foreign members and Rs. 5000/- for Indian members. Indian institutional life membership is Rs. 10,000/-. I certify that the information provided above is accurate and correct. Total Cheque $/Rs.__________________________ Drawn at _________________________ Signature of applicant : ___________________________ Date : ____________________________ Please send application form thru email after depositing Subscription in Journal's account in Punjab National Bank to B.L. Dubey, Ph.D. Editor Emeritus, Email:bldubey@gmail.com with a copy to Rakesh Pandey, Ph.D. Editor in Chief, Email: rpan_in@yahoo.com.

STATEMENT SHOWING OWNERSHIP AND OTHER PARTICULARS ABOUT SIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH PLACE OF PUBLICATION : Dept. of Psychology, Banaras Hindu University, Varanasi-221005 PERIODICITY OF PUBLICATION : Half Yearly EDITOR’S PRINTER’S Name : Rakesh Pandey PUBLISHER’S NATIONALITY : Indian ADDRESS : Dept. of Psychology, Banaras Hindu University, Varanasi-221005 OWNER : SOMATIC INKBLOT SOCIETY I, Dr. Rakesh Pandey, hereby declare that the particulars given above are true to the best of my knowledge and belief. Sd/ Dr. Rakesh Pandey, Editor-in-Chief SIS Journal of Projective Psychology and Mental Health Published by Dr. Rakesh Pandey, on behalf of Somatic Inkblot Society at Prasad Psycho Corporation (Printing Dept.), New Delhi, Ph. 011-43203333 Editor-in-Chief : Rakesh Pandey

SSIS JOURNAL OF PROJECTIVE PSYCHOLOGY AND MENTAL HEALTH: ACHIEVEMENTS Journal in WHO Listing Members of Somatic Inkblot Society will be glad to know that SIS Jr. of Projective Psychology and Mental Health has been listed by World Health Organization (Global Forum for Health Research) among 25 indexed journals that have published the highest number of articles on mental health from LMICs in Latin America, Africa and Asia (Medline and PsycINFO). Extract from table-6 of “Research Capacity for Mental Health in Low - and Middle - Income Countries: Results of a Mapping Project “(www.globalforumhealth.org) is given below: Journal in Pro Quest Listing: We are glad to inform you that SIS Journal of Projective Psychology & Mental Health has been listed in academic research database ProQuest Psychology Journals™. ProQuest is a company in Michigan, United States. It is a leading provider of electronic databases for academic libraries. Databases are used in over 20,000 academic libraries around the country and around the world including some of the most prestigious higher education institutions such as Harvard, Yale, Princeton, Oxford ect. ProQuest provides abstracts and indexing for more than 640 titles, with over 540 titles available in full text. Users get access to charts, diagrams, graphs, tables, photos, and other graphical elements essential to psychological research. Rank Journal Country Language Revista de Psicoanalisis Argentina Spanish Revista de Neurologia Spain Spanish RevistaBrasileria de Psiquiatria Brazil Eng.,Spani.,Portuguese, Arquivos de Neuro-psiquiatria Brazil Portuguese ActaPsiquiatrica y psicologica de AmerciaLaina Argentina Spanish Journal of the Medical Association of Thailand Thailand English, Thai 7 British Journal of Psychiatry UK English ActaPsychiatricaScandinavica Denmark English SaludMentale Mexico Spanish Vertex Argentina Spanish Journal of Personality and Clinical Studies India English Social Psychiatry and Psychiatric Epidemiology Germany English RevistaMedica de Chile Chile Spanish South African Journal of Psychology South Africa Afrikaans, English Psychological Reports USA English South African Medical Journal South Africa Afrikaans, English The Australian & New Zealand Jr. of Psychiatry Australia English International Journal of Social Psychiatry U. K. English Psychiatry Research Ireland English Social Science & Medicine U. K. English Revista De SaudePublica Brazil Portuguese International Journal of Geriatric Psychiatry U. K. English SIS Jr. of Projective Psychology & Mental Health India English Journal Brasilerio de Psiquiatria Brazil Portuguese Psychiatry and Clinical Neurosciences Australia English

Abstracted in “APA's Psyc INFO “ Regd. No. 71632/99, RNI Delhi SIS JOURNAL OF PROJECTIVE PSYCHOLOGY & MENTAL HEALTH Volume 21 Number 2 July, 2014 EDITORS EMERITUS Wilfred A. Cassell, MD, Director, SIS Center, 4501E,104th Avenue, Anchorage, AK.99516 (USA). E-Mail: siswilfredacassell@yahoo.com Bankey L. Dubey, Ph.D., Director SIS Centre,4406 Forest Rd, Anchorage, AK 99517, E-mail: bldubey@gmail.com Amool R. Singh, Ph.D., Prof. Clinical Psychology, RINPAS, Kanke, Ranchi-834006 E-mail:sisamool@yahoo.com EDITOR-IN-CHIEF : Rakesh Pandey, Ph.D. Professor, Dept. of Psychology, BHU, Varanasi-221005 E-Mail: rpan_in@yahoo.com EDITORS : Silvia Daini, M.D., Instituto di Psichiatria e Psicologia, Università Cattolica del SacroCuore, Roma, Largo Francesco Vito 1, 00168, Rome ( Italy) Email: daini@katamail.com Anand Dubey, MBA, 4406 Forrest Road,Anchorage, AK 99517(USA) E-Mail: anand.dubey@gmail.com L. Sam S. Manickam, Ph.D., Professor Clin.Psych.Dept of Psychiatry, JSS University, Mysore-570004, Email: lssmanickam@gmail.com Nilanjana Sanyal, Ph.D., Prof. Dept. of Psy, University of Calcutta, 92 A. P. C Road, Kolkata-700009 Email: sanyal_nilanjana2004@rediffmai.com, M. P. Singh, Ph.D. 1329, Sec.70,Guru TegBahadur Complex, SAS Nagar (Punjab) Email: mpsingh1329@gmail.com EDITORIAL CONSULTANT Yogesh K. Arya, Ph.D., India Jayanti Basu, Ph.D. India Antonio Cervigni, M.A., Italy Suprakash Chaudhury, M.D., Ph.D. Carina Coulacoglou, Ph.D., Greece Manisha Dasgupta, Ph.D. India Padma Dwivedi, M.A., USA Anatoly B. Khromov. Ph.D., Russia H. Kumar, Ph.D., USA Rakesh Kumar, Ph.D., India Ranjeet Kumar, Ph.D., India Lisa Milne, Ph.D., Australia Nalini Mishra, Ph.D., India Tilottama Mukharjee, Ph.D., India Arvind K. Keshary, Ph.D. India Paola Nicolini, M.A., Italy Edward M. Petrosky, Ph.D., U.S.A. Stefano Reschini, M.A, Italy Barry A. Ritzier, Ph.D., U.S.A. Brig. D. Saldanha, M.D. India Radhe Shyam, Ph.D.India Umed Singh, Ph.D. India Kranti Srivastava, Ph.D. India Ajay Tiwari, Ph.D., India Ailo Uhinki, Ps.D., Finland Yasho V. Verma, Ph.D., India Robert B. Williams, Ph.D., Canada