Mr X, 29 years, PhD student, presented in July 1992 with recurrent loss of hair over scalp, arms, legs and trunk for last 23 years. His mother had history of AA and bronchial asthma. In view of alopecia totals, he was treated with prednisolone pulse, 300 mg once a month for four months and had complete loss of hair (Sharma 1996). Subsequently, he presented with relapse of alopecia totals in July 1994 and gave history of stress due to conflict with PhD guide. He was treated with topical sensitize diphencyprone and had complete loss of hair in 6 months and is on maintenance therapy for almost 3 years.
As he narrated, he was frequently given severe beating by his father to the extent of physical abuse. He perceives his father to be very authoritarian, aggressive and dominant, leading to frequent quarrels between his parents. He is aggressive towards his brother and sister. He finds it to be a broken family. He has few friends and very limited contacts. He got familiar with a female university student and soon married her. It is a sort of arranged marriage by his friends, though his parents gave their consent at the end. Initially, he was withdrawn from his wife as he was feeling sexually weak. There was problem of erection, which improved to some extent after medication. Medical treatment and supportive psychotherapy helped in improving his symptoms.
A few significant responses on somatic inkblot test with content analysis are given as follows:
A5: He perceived this image as ‘a man crying for freedom with his body torn apart’. It brings out his inner cry and desire to get away from his broken family home. He further confirmed this feeling during interview and therapy session. He does not find his home worth living and wants to flee.
A10: He has viewed this image as ‘the face of a gloomy woman marred by distressful life’. It may depict his projection towards his mother who often suffered physical assault from his father and is depressed. The patient projects that most of the Indian families have such bad atmosphere. This may also bring out his sympathy towards his mother and his inability to help her because of the dominant father.
A13: He saw ‘the hand/palm of a person caught in a fire as if crying out for help’. Once again, his inner cry has come out on surface indicating that he needs help from others. This may also be indicative of his wishful thinking to get support and help from his physician/therapist for his physical symptoms in the form of alopecia or even sexual inadequacy.
A15: He has seen ‘an infant priced/pierced/stabbed by a long knife in womb itself’. This may be indicative of his regressive phenomenon, which takes the person back in time and he feels that it could have been better if he had died as a foetus. It suggests his depressive mood and that the person wants to bring the womb itself may also be indicative of severe pain inflicted by his father during his early childhood. Such information is very important for a therapist as it helps him in therapeutic intervention.
A22: He viewed it as a ‘scorpion’ rather than seeing it as backbone or male genital organ. The plausible explanation could be that because of his ‘impotence’ he has avoided seeing backbone/male sex organ even on suggestion. Since it is painful to think of impotence to a newly married person, he has projected it as a ‘scorpion’—a pain-inducing insect.
A23: He has seen ‘a baby scorpion’. Once again, the imagery of male genital organ has been suppressed and painful imagination in form of a scorpion is brought out on the surface. The other possible explanation could be his injured ‘tailbone’ because of which he had endured lot of pain and suffering a few years ago.
A31: He perceived ‘a couple shares their common woes’ on this image. Seeing a couple is the most typical response but ‘common woes’ may bring out his inner cry particularly because of his sexual weakness and inability to perform the role of a husband.
B4: He viewed in this image ‘a happy man but a woeful woman’, suggesting his projection of seeing his wife under woeful imagery. This may also be the projection of his mother whom he always finds in a miserable situation. Again, the theme of disturbed family life and his own withdrawal from reality as a deference mechanism has been brought out.
B11: He has seen ‘a wig kept on the head of a person’. This may suggest his fear of becoming ‘bald’. The loss of hair due to AA has created in him a lot of tension and he is worried to the extent of becoming bald. Such anxiety is quite expected in a young man.
B20: He viewed ‘the rear view of a head with long hair’ which suggests his wishful thinking to have long hair. He further elaborates that he has seen his own photograph with long hair and wishes to have long hair once again.
B28: He has seen ‘a distressful passionate person’ in this image, which people generally see as ‘a lady with her child’. Avoiding seeing a lady may be due to his conflict with his wife and ‘passionate person’ could be the projection of himself.
B31: He has seen ‘a family with their children knitted together tightly out of some unknown uncertainty/fear/upheaval or resolution’ in this image. Since it is the last mage of the test, the theme of a happy family is projected in this image so that the person could carry positive feeling at the end of the test. Instead of seeing a happy family, he had seen a family with their children knitted together tightly is a painful back in time to help him to process the painful memories of childhood. Physical abuse, lot of uncertainty and strict discipline might be a few of the reasons for such an imagination.
It can be concluded that the SIS had helped the patient in projecting the painful childhood experiences, disturbed family relationship and fear of being bald and disturbed physical/emotional relationship with his wife. The test had further helped in establishing the psychopathology leading to psychosomatic disturbances (AA) and the need for counselling.
AA is known to be associated with emotional factors (Dubey and Das 1977). In recent study from India, emotional factors were clamed in 7 per cent cases (Sharma et al. 1996). It is painful to accept and reveal one’s own sufferings in front of a physician, but the patient feels comfortable to project his sufferings through the inkblot images and accepts this during analysis.