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Journal of Projective Psychology and Mental Health: Volume 17, Number 2, July 2010 Editorial

1. Editorial: Genetic Determinants of SIS Projection, Wilfred A. Cassell, pages 101-103.

A 21st century scientist, conceptualizing the neuropsychological mechanisms underlying projection, has available more sophisticated scientific studies than in the past. This information is available to those building on SIS body-mind-spirit concepts envisioned in the preceding century involving visual and auditory sensory input. Now, more advanced systems based on evolving projective theory can incorporate additional sources of ambiguous multidimensional sensory input.

Smell has potency as a trigger for the release of deep seated memories, including olfactory stimuli, and warrants consideration. Such inclusion should prove promising, especially in certain disorders triggered by stressful life events. In futuristic thinking, look forward to scientific breakthroughs by innovative developers of projective procedures. It is predicted that many will concurrently monitor and/or stimulate various physiological and psychological dimensions.

Advanced research centers using sophisticated computer controlled electronic technology have methodologically moved beyond clarifying diagnostic considerations and focus more on therapeutic applications. As an illustration, in America investigators are now actively exploring the use of “Vestigial Reality” inducing technology in combat-induced PTSD. Of course, such work is not without its hazards. (It may be recalled that in 2009 a psychiatrist in the United States military that was occupationally exposed to secondary or empathetic PTSD ended up homicidal. Of course, because he was Moslem, many asserted that his true motivation for homicide really was terrorism.)

Overall there has been an explosion in both the professional literature and the public media related to PTSD. One promising area of scientific research involves pharmacologic attempts to reduce symptoms triggered by severely stressful events. For example, morphine has been found to have this effect in civilian victims of road accidents, children suffering from major burns and injured American combat soldiers. It is unclear the extent that this preventative action reflects the opiates’ analgesic action, as contrasted to its noradrenergic effect in blocking the consolidation of PTSD memories.

There are similar unknowns with SIS research. While there is considerable clinical evidence based upon individual case histories describing the therapeutic value of the technique, as yet there have been no controlled studies attempted. Caution is definitely indicated. Evidence is emerging that for some PTSD victims, that triggering stressful memories can actually aggravate their symptoms.

The current literature is controversial due to the inherent complexity of mental disorders. Yet, many of our original published clinical cases showed dramatic improvement, after emotionally painful imagery was triggered by a traumatic scene reactivating SIS “inkblot”. Such a stimulus clearly can have the pulling power to bring back to the victim’s mind confused cognitions/emotions. In the detailed enquiry, cognitively reprocessing these in a secure empathetic therapeutic environment, away from the original stressful situation, seemed to be helpful.

Also, the repetition of the key triggering stimulus that effectively brought into projective awareness traumatic imagery, followed by relaxing nature scenes may have added a behavioral therapy like effect. This aspect of SIS viewing may activate the high-frequency waves associated with attention and introspection during meditation. Such repetitive reconditioning of the brain’s memory neurons mimics Nature’s homeostatic healing process. Since this may occur during REM sleep in less intelligent animals, it may not require much in the way of conscious cognition. However, with humans, SIS therapy, in addition to neural conditioning, can be worthwhile for the victim to learn to interpret symbolic imagery, linked to PTSD dreams. Over time, these change from photographic-like traumatic scene reproductions, to less stressful disguised dream symbols. With successful SIS therapy, ultimately these become affect neutral, and the individual’s sleep is no longer disturbed.

Also, when the victim observes, or senses that the therapist concurrently suffers secondary empathetic emotional discomfort during repeated sessions, the intimacy and bonding is enhanced. Severe pain, either from physical or psychological injury, invariably is associated with an observable degree of age regression. Clinical manifestations of this phenomenon may emerge in such a way, as immature voices, and profuse crying out to an imagined parental figure. When the therapist empathetically plays this role, no longer does the individual have to feel childlike and alone, in suffering subjective torment. Facilitating this dysphoric affect transfer (i.e. “Dumping on the therapist”) can play a supportive role. Over time, it can also enable the sufferer to conceptualize the misperceived original stressful circumstances more maturely, in a reality based fashion. If the original stressors involved abuse by a perpetrator, witnessing the therapist experience a degree of anger towards that individual can enable the victim to do the same. This can assist in removing self blame, and irrational based guilt. In addition, it can augment insight when the victim realizes that the human imagery projected onto SIS figures depicting past abusive figures may also erroneously distort current social perceptions - including false transference impressions of the empathetic psychotherapist.

Next, for illustration purposes, consideration will be given to instances of protracted severe childhood stress. In vulnerable children this can theoretically result in ego splitting, such as observed in the Dissociative Disorders. Consider an Identity Disorder condition, which was formerly called “Multiple Personality Disorder”. Here part of the victim’s identity may have been linked with the aggressor, so the above outlined empathetic transfer therapeutic process may be especially critical. Otherwise the victim may be prone to acting out patterns mimicking the original abuser.

The history of knowledge is rapidly expanding in regard to stress related disorders. There is more recognition, in this age, being given to the fact that managing cases of PTSD expose mental health workers to occupationally induced secondary empathic dramatization. SIS therapists have a relatively greater hazard, because of this projective technique’s great pulling power to evoke emotionally charged horrible scenes. In jointly viewing a triggering SIS stimulus pattern, the professional’s visual apparatus and its related emotional/cognitive brain centers involving higher function are activated, albeit at a lower intensity level, but still in an analogous way to the victim’s nervous system.

. Similarly, professionals working in other fields concerned with human suffering are also at risk. For medical providers, emergency room physicians have a much higher “burnout” rate and shorter life span than those in other medical specialties. In a like fashion, those who provide emergency care in war torn countries expose their own dream REM states to secondary empathetic PTSD imagery. Ordinarily such professionals tend to minimize this hazard in verbal reports, so it is hard to obtain objective data.

An exception exists in a book published in 2009 by James Orbinski entitled “An Incomplete Offer.” In this he documented both the reality of his original traumatic experiences in Rwanda. These included treating physically/ psychologically brutalized adults and children during the genocide period (e.g. One girl’s traumatic memories shared with him included recollection of hiding in a latrine covered by human wastes, then peering out and witnessing her mother’s torture and bleeding to death after limb amputation. Throughout the period perpetrators cut off children’s body parts and sent them to care providers as a warning etc. etc.). His documentary provides examples of his related sleep-disturbing dreams and “flashbacks” suffered years later.

In considering the importance of empathy during SIS clinical work, this phenomenon has been studied by investigators in a number of scientific disciplines and found to be impaired in psychiatric/neurological conditions. For example, neuroscientists at the University of Chicago using fMRI scans have found reduced “empathy neurocircuitry” in adolescent boys diagnosed with Aggressive-conduct Disorder. Related work has indicated that in subjects instructed to think compassionate thoughts, such brain circuits are activated. In this connection, some individuals can be taught empathetic skills. This may prove to be one helpful function of psychotherapy. This especially applies in children and young people, if it involves constructive play with animals.

Experiencing the therapist’s empathetic suffering may allow the intact portion of such a “split personality” to identify with the professional’s corrective empathetic affect towards the disturbing SIS released PTSD imagery. In this way the individual with the fractured sense of self, in therapy, may learn to identify less with a powerful past perpetrator. Concurrently, the healthy portion of the ego may become more empathetic and compassionate to its own long forgotten “inner cry”.

Clearly, future attention needs to be given to the investigation of such intimate psychophysiologic phenomenology of the two person interaction during SIS detailed enquiry. For example, an investigator might use a standard illustrative recorded SIS PTSD interview, involving a traumatic accident scene as a test stimulus, and then monitor the empathetic reactions of various subjects.

Against this background, it might be helpful to add to existing SIS projective theory by incorporating in the conceptual model, genetic factors. Some vulnerable individuals may be genetically predisposed, under stressful conditions, to develop PTSD. As yet, SIS investigators have not initiated studies involving identical twins. Some may believe that contemplating such research requires too great a leap in conceptualization. Still, it may provide guidelines to keep in mind the various related studies that this journal has published. It may be recalled that many of these illustrate how SIS response patterns that have anatomical/human content relate to socialization and empathy.

In the basic sciences, studies relative to an organism’s interest in social interaction indicate that an organism’s DNA content can shape this basic process. For example, flat worms that possess a predominance of a particular gene have been observed to isolate themselves. In contrast, those at the opposite genetic pole have been found to seek out groups.

In primates, neuroscientists have also studied basic biological mechanisms, shaping socialization and empathy. Work completed on the so-called “Mirror Neurons” in the brains of monkeys is an example. As more is learned about genetic determinants in humans, researchers may eventually determine the extent to which comparable genetic influences might shape avoidance or seek out human content in the SIS.

Of theoretical relevance are clinical studies involving the Autism spectrum. If one identical twin suffers from Autism, the likelihood is approximately 90% that his or her twin would also be autistic. Children with this disorder (like the flatworms loaded with social isolation genes) also prefer being alone. Consistent with this, eye movement studies indicate that, when viewing a picture of the face, characteristically they avoid looking at the person’s eyes. It would be helpful to ascertain if this same autistic avoidance would show up with SIS facial stimuli.

Since the severe form condition occurs in about one percent of births and is increasing in prevalence, this could open up a fascinating avenue of future investigation for SIS scientists. Many modern geneticists think that in the overall population, various degrees of the genetic defect exist on a spectrum. Projective studies could be designed, using advanced technologically supported multidimensional input, to statistically sort out the degree to which empathy relates to social learning versus genetics.

SIS scores assessing projected human imagery might provide useful aids in pursuing future scientific knowledge concerning this positive aspect of human identity.

2. SIS II-Video and Treatment of Alcoholism, Wilfred A. Cassell and Bankey L. Dubey, pages 104-119.

The Somatic Inkblots Video was administered to a person who has been abusing Alcohol and other drugs for the last 25 years. The SIS images helped in planning therapeutic intervention leading to a positive attitude towards life. He shared the emotional pain which he has felt during past years on his job. The Video interaction will help in understanding the psychopathology of such cases that have a lot of inner crying to share with someone, particularly with the therapist.

3. Development of a Comprehensive Scoring System for SIS-I, S. Kandhari, J.Sharma and R. Kumar, pages 120-125.

Many researchers working with SIS-I have felt the need of an extended scoring system for the test. After an extensive review of the literature available on inkblots, the Comprehensive Scoring System (CSS) for SIS-I was developed on the basis of Beck’s scoring system for Rorschach. The present study aims at delineating the pattern of responses on SIS-I in normal persons. SIS-I was administered on 200 normal persons drawn from the general population. The CSS indices were enumerated and defined operationally for objective scoring. The SIS-I protocols of the sample were scored as per the developed CSS. Mean and S.D. of each scoring index of the Comprehensive Scoring System were computed. The results are presented.

4. Prior Exposure to the Rorschach Test and Differences in Selected Rorschach Variables, Felicia Castro-Villarreal, pages 126-134.

The present study examined the effect of prior exposure to the Rorschach on selected Rorschach variables. An availability sample of Mexican-American undergraduate students (N = 59) was randomly assigned to one of two conditions: (a) an experimental group (n = 28) or (b) a control group (n = 31). Experimental participants were exposed to Card I of the Rorschach at Time 1 and one week later at Time 2. Control participants were exposed to the same card at Time 2 only. Both groups provided demographic information. Response differences were investigated using independent t-test analyses. As hypothesized due to increased media and pop-culture exposure and the release of all ten cards on Wikipedia, the majority of participants reported having seen the Rorschach before. However, between-group differences on the dependent variables were not significant; thus prior exposure did not differentially impact response on selected Rorschach variables. Implications are presented with regard to the validity of Rorschach administration, scoring, and interpretation, support for the appropriateness of re-testing, test security issues, and to undercut efforts to opt out of being administered the Rorschach on the basis of prior exposure. Research with a Mexican- American sample is also noted as a much needed addition to the Rorschach literature base.

5. Emotion and Health: An overview, Rakesh Pandey and Anil Choubey , pages 135-152.

The relationship between emotion and health has been a focus of scientific inquiry in psychology for a long time but it occupied a pivotal position with the advent of Alexander’s psychosomatic paradigm. Since then, a number of affect related constructs have been explicated with potential implications for health. The present paper makes an attempt to review the role of some affect-related constructs in health that have been the centre of attention in contemporary psychological research. We have reviewed empirical evidence that demonstrates the relationship of such affect related constructs, as emotion regulation, emotional disclosure, emotional intelligence, alexithymia, positive/negative affect, and affect intensity with health. In general, the review suggests that some affect-related constructs such as cognitive regulations of emotion, emotional disclosure, positive emotional experiences and most of the dimensions of emotional intelligence have a beneficial influence on the health status of an individual. On the other hand, such affect related variables as effortful suppression of emotions, alexithymia, affect intensity, and negative emotional experiences have adverse consequences for health. As far as the role of valence and magnitude of emotional experience is concerned, the existing literature suggests that high intensity of experienced emotion has an adverse effect on health irrespective of the emotional valence. The potential mediating mechanisms linking various affect-related dimensions to health have also been reviewed. Future research, however, is needed to develop an integrated holistic theory of health based on affect-related variables.

6. Mental Health and Quality of Life of Chronic Pelvic Pain and Endometriosis Patients, Anand Kumar, Vidhi Gupta and Avita Maurya, pages 153-157.

The study explored depression and alienation aspects of mental health in chronic pelvic pain and endometriosis patients and assessed their quality of life in Indian cultural conditions. Asha - Deep Depression Scale (Kumar, 2002), Alienation Scale (Patil, 1989) and P.G.I. Quality of Life Scale (Moudgil et al., 1998) were administered to100 females with chronic pelvic pain, 100 endometriosis patients and 100 normal females.. Findings revealed that chronic pelvic pain patients were found to be depressed, highly alienated and they exhibited impaired quality of life as compared to endometriosis patients. Such patients have pessimistic attitude, exhibit marked social withdrawal, negative self image, fatigue, lack of interest in their work, worthlessness and, decreased sex desire and motor activities as compared to endometriosis patients. Cognitive behavior therapy is suggested for improvement of their mental health.

7. Rorschach Profile of Manic Patients, Deapti Mishra, Khalique and Ranjeet Kumar, pages 158-164.

This study has been designed to find the response pattern of mania patients on Rorschach by using the Exner comprehensive system. Main objective of the study was to develop a profile of mania patients on Rorschach variables. 120 Bipolar Affective disorders patients, current episode mania with psychotic features, ranging in 18-55 years of age, diagnosed as per ICD-10, and 50 randomly selected normal subjects from the general population, matched with respect to age and sex with mania group were included. Findings of the study indicate that mania patients differ significantly from normal control on several Rorschach variables.

8. A Single Case in Interpretative Wrappings of Multiple Psychological Theories, Somdeb Mitra and Nilanjana Sanyal, pages 165-170.

Throughout the history of clinical psychology, different psychological theories have provided insights into psychological distress from different perspectives. The current paper attempts to provide an integrated understanding of different theories while understanding the psychopathology of a single case. It is argued here that such an understanding can help in the effective treatment process as the therapist can be more flexible, empowered by a more in-depth understanding of the phenomena that arise during the process of psychotherapy.

9. Attempted Suicide: psychopathology and Wartegg Test indicators, S. Daini, A. Manzo, F. Pisani and A. Tancredi 171-177.

In this work we suggest the potential clinical utility of the Wartegg Test, on the pathway of patients attempting suicide. The Wartegg test is a projective procedure composed of eight panels with eight semi-structured stimulus-signs.The exploration of the projective dynamics seems to play an important role in gaining further in knowledge of psychopathological issues, which is the reason why a projective test administered as a simple and fast Wartegg test was chosen. The study comparatively analyzes the differences in the responses given to each test panel, drawn by subjects who attempted suicide, both with and without psychiatric disorders, and by a further group of depressed patients having no history of suicide attempts.

The study was also aimed at carrying out an initial exploration of the Wartegg method as source indicators of suicidal risk. The survey sample consists of three groups registered as Attempted Suicide (AS= No. 25), Depression (D=No.29), Control (C=No.29). Groups AS and D consist of patients diagnosed and treated at the Day Hospital Service of the Gemelli Hospital. The control group consists of students of the Gemelli Hospital and other subjects who never received any kind of treatment. In conclusion, our work confirms the importance of the depressive component in suicide attempts, indicating a failure to differentiate between the results obtained by the group of patients who attempted suicide and the group of depressed patients. Significant differences appear to be more relevant for what concerns the control group. In t his comparison, the suicide attempt seems connected to the emergence of a conflict in feelings.

10. SIS-II Profile of Patient with Antisocial Personality: A case report, Kiran Bala, D. K. Mishra and Masroor Jahan, pages 178-179.

This is a case report of a 20 years old male, educated up to ninth standard, taking alcohol, ganja, brown sugar (smack), cigarette, and tobacco for the last 5 yrs. According to ICD-10 he was diagnosed as a case of Mental and Behavioral Disorder. On psychological evaluation he was guarded and nothing could be elicited except inadequate parenting and family problems. However, on SIS he could not conceal his personality and antisocial traits. The diagnostic /treatment applications of this projective interview aide are the main objective of this case history presentation.

11. Rorschach Profile of Indian Adults, Shweta, R.C.Bajpai, K.S.Sengar, A. R. Singh and N. G. Desai, pages 180-186.

The present study aimed to develop the normative data on the Rorschach Test and present a comparative view of Indian male and females. Subjects for the study were taken from Delhi by using systematic random sampling techniques. The Rorschach InkBlot Test was administered to 238 subjects, consisting of 130 male and 108 females by following the Beck system of administration. Chi-square, t-test and U-test were computed to compare the Rorschach variables. Result obtained on Rorschach protocol of normal Indian adults does not show significant difference between Male and females except on two variables-Dd and Sex. Results are in contrast with western norms and to some extent with Indian studies also. In addition, religious responses on the Rorschach Test focus on some newer type of content and open up a new dimension of further research. In the absence of any standardized Indian norms, analysis and interpretation of Rorschach protocols would be mala-fide. So, the foremost work will be to set standard Indian norms which may comply with the parameters of Indian socio-cultural settings.

12. SIS – II Profile of Epileptic Patients, Deepak K. Mishra, Sarika Alreja, Masroor Jahan and Amool R. Singh, pages 187-191.

The present study intends to investigate the SIS- II profile of patients suffering from epilepsy. Fifty (50) epileptic patients attending OPD and community outreach program of Ranchi Institute of Neuropsychiatry and Allied Science (RINPAS), Ranchi, India and 50 normal participants were administered the Somatic Inkblot Series Booklet Version (SIS-II). Results reveal significant differences between patients of epilepsy and normal participants on most of the indices of SIS II. Most typical response, Depression and Rejection of images were found as the most discriminating diagnostic indicators.

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