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Three case histories involving individuals suffering from existential death anxiety were administered the Rorschach Inkblot Test to illustrate the responses indicating symbolic death content and death anxiety. The over emphasis on somatic content (many „Anatomical‟ responses) on Inkblot tests, might reflected the presence of unconscious anxiety and anticipated decay of one‟s physical body, may be the plausible symbolic interpretation and indicator of death anxiety. This is not possible if the responses are interpreted using quantitative analysis. In addition,the somatic content demonstrates the healing power of spiritual symbols. The paper will motivate young clinicians and clinical psychologists to use content interpretation to understand the power of projection and take advantage of spiritual symbolism during therapy.
Subjects related to death and dying have been an area of clinical concern in the literature (Weisman, 1972). As a result, more psychologically sensitive approaches for assisting the dying patient are now evolving. However, questions may be raised concerning the applicability of those accumulating insights to psychological and psychiatric practice. Are fears of death seen in other than terminal patients, and if so, how many they be evaluated by psychological testing?
In attempting to find an answer to this question, attention might be initially given to the psychoanalytic literature. Freud (1953) originally introduces the concept of “thanatos” or death instinct considered to play a significant role in certain types of mental functioning. However, he did not fully develop this concept in his later work. Becker (1973) has suggested that this failure to enlarge upon this theme was due to the fact that he suffered from a type of “Thanatos phobia” himself. The latter, according to Becker, manifested itself psychophysiologically in certain of Freud‟s fainting spells which were precipitated when he was confronted on the subject of dying by Jung.
Perhaps because many, like Freud, find the subject anxiety provoking, with the exception of the existential therapists, it has tended to remain in the background of thinking relative to everyday clinical practices.
This is not surprising since according to Kubler-Ross (1969) that “in our unconscious death is never possible in regard to ourselves”. What is written about the subject appears infrequently but when it does, it is claimed that death anxiety plays a significant role in many of the common metal disorders; for example, Zilboorg (1943) reported that “There always lurks the basic fear of death, a fear which manifests itself many ways. One is free of the fear of death…. the anxiety neuroses, the various phobic states, even a considerable number of depressive suicidal states and schizophrenias amply demonstrate the ever present feat of death which becomes woven into major conflicts of the given psychopathological conditions. We may take for granted that the fear of death is always present in our metal functioning”. Along the same line, Wahl (1959) indicated that in children and adolescent many neurotic symptoms are primarily related to the fear of deaths. He reported that “The child‟s concept of death is not a single thing, but rather a composite mutually contradictory of paradoxes… death itself is not a state but a complex symbol, the significance of which will vary from one person to another and from one culture to another”.
It is suggested that, the resistance in exploring the psychopathological significance of death anxiety is not just related to the clinician's own discomfort with the subject. It
Wilfred A. Cassell, M.D., FAPS, APC, and Bankey L. Dubey, Ph.D., D.M.S.P. Director SIS Center, 4406 Forrest Road, Anchorage, AK 99517 (USA), Email: bldubey@gmail.com.
Key Words: Death anxiety, Fears of death.
also pertains to the fact that in ordinary mental functioning, this type of existent anxiety is strongly repressed. In one psychopathological theory of personality structure which encompasses this subject, Perls (1969) conceived of a neurotic structure as a thin edifice built upon four layers. At the deepest layer man‟s fear of death exist. Only when we get to this fourth layer says Peels, we get to the “authentic self?”
Based on the depth nature of such material, objective studies in this area are very difficult. The vast majority of patients, even when faced with medically document terminal illness, disclaim fear of deaths on a verbal level (Feifel et al, 1973: Levine & Zigler 1975). Professor Ernest Becker, won the Pulitzer book prize for publishing "THE DENIAL of DEATH" has expressed that most people cope with their personal fears of dying by employing the mental mechanism of Denial (Cassell, 2017; Cassell & Dubey, 2016).
Cassell, et al, (2013) using the Somatic Inkblot Series SIS-II dealt with the seemingly impossible perception of one‟s own dead body. It involved a Vietnam solder suffering from Combat PTSD, who in a transient psychotic state hallucinated seeing his own dead body in a mass grave along with those of deceased loved ones. The unique case enables the reader to graphically understand the clinical concomitants of severe Death Anxiety. In addition, it also demonstrates the healing power of spiritual symbols, yoga powered spiritual imagery (Cassell, 2011). As a follow-up introspective illustration, Cassell (2014) reported a vivid “Death Dream” that strongly suggested viewing an “Afterlife” mystical continent-symbolic of death anxiety.
Certain workers have also attempted to resolve this problem by employing psychological techniques to evaluate death anxiety at the subconscious as well as the conscious level. An example of an approach in this regard is the use of the word association test, which measures the subject‟s reaction times to words associated with death (e.g. "coffin", "funeral", etc.). By means of this
procedure, it has been shown that dying heart and cancer patients take significantly loner to respond to death related as compared to neutral words. As a result of such work it has been concluded that terminal patients, as compared to non-terminal patients are more afraid of death on an unconscious level, although most deny such fears when interviewed about their conscious concerns. Other investigators have tried to examine the same level of unconscious material by measuring a subject's autonomic nervous system responses to related words (Alexander, 1957; Greenberg & Alexander 1962; Golding, 1966).
The relative depth nature of such studies dramatically emphasizes the practical problem facing the clinician who might wish, to follow this line of inquiry in diagnostic interviewing. If dying patients who are informed of
the gravity to their somatic condition, tend to deny fears of dying, consider how much more difficult it is to identify and assess the significance of death anxiety in non-terminal patients. This is especially true where the threat of dying is ordinarily much more intangible having primarily existential considerations.
It would therefore appear that there is a need for further evaluations techniques in this area, especially those which have the capacity to tap the unconscious level of functioning. As a possible contribution to clinical investigation in this field, the present report proposes to introduce a new conceptualization of death anxiety which lends itself to projective assessment? The conceptual background is derived from a series of studies by one of the author on body perception (Cassell, 1964, 1965, 1969, 1972, 1977). It is based upon the view that fears of dying, even though originating in what at time may be essentially philosophical considerations, are ultimately experience by the ego as anxiety about the state of the body. If the latter are not properly resolved, it is postulated that there can result heightened body cathexis which manifests itself objectively by a tendency for the
individual to project pathologic anatomical responses when viewing ambiguous stimuli, such as inkblots. It is suggested that the last provided a clinical measure of the individual‟s death anxiety at an unconscious level.
Against this conceptual background, perhaps it might be useful to briefly review certain case histories which illustrate the phenomenology under discussion. Hence, several cases are presented below.
The first patient- a 47 year old married woman
- was originally referred for psychiatric evaluation and treatment of severe pelvic pain. While the pain was experienced in all pelvic structure, it did tend to be more severe in the area of the right ischial tuberosity. Subjectively she described it as being in the rectal area, right hip and lower back. She described it as being a “very searing, not jabbing pain” that “worked up” in intensity. The patient‟s medical history indicated that she had originally developed ulcerative colitis at
41 years of age and four years later developed cancer of the bowel. Surgery had removed the lower bowel including, most of the rectum. Following this she had a permanent colostomy. Her pain symptoms had developed shortly after surgery in the absence of any recurrence of her primary disease.
What was remarkable about her clinical history was her apparent lack of concern in regard to the potential life - threatening aspects of the cancer. This is perhaps best illustrated by considering a portion of a tape recorded interview.
Patient: “I had ulcerative colitis for quite a few years and then it was… it would be four years ago...I believe it's four years four.. .at Christmas time all of a sudden after that I started to bleed from the rectum and I didn't tell any or say anything about it until the middle of February... and then they made me to go to see Dr. Z. and he set up a barium right away to look at things and when I was waiting for the results I flew to Vancouver and
had a holiday with my sister...I was trying to forget about this for a while but when I got hack he told me that I was just like ostrich sticking my head in the sand And not knowing what was the matter with me.
Doctor: What was the eventual diagnosis? Patient: It was cancer.
Doctor: I see.
Patient: And he (the surgeon) had a very good idea at the time that this is what was...he just didn't say...he wanted to be definitely sure.
Doctor: How did you feel when he told you that you had cancer?
Patient: You know I can't remember his telling me this…. not until everything was over. I know my husband knew., .and whether they had me drugged and told me I don't remember but I really don't know remember telling him until everything was over with...it and it didn't bother me because he said that he got it all out...they told me I would be a new girl and everything would be fine...you know they gave me a temporary colostomy.
Doctor: You say it didn't bother you that you had cancer. Could your clarify that?
Patient: Well some people would worry and think well you know, I've had this...maybe I've still got it and you know...but it didn't bother me.
Doctor: Has it bothered you since? Do you ever think about it?
Patient: Oh...once in a great while I may be think about it but not really.
In reviewing this interview, it might be noted that she used the mechanism of denial and repression in responding to her life - threatening disease. This led her to initially delay in seeking medical treatment. In conceptualizing of her psychosomatic symptom, it may be noted that there was only pain in conscious awareness, not anxiety about her body status. It is hypothesized that, the somatic discomfort represented the conscious equivalent of her unconscious
psyche distress. In considering this formulation attention might be next given to examining her unconscious body attitudes as revealed in her anatomical responses projected with Rorschach testing. Initially, the test was administered in the traditional way with the following results in regard to content.
Card I: “Bug…Bat…Beetle”
Card II: “X-ray of pelvis… Kidney…
Card III: “Two people… funny looking drops of blood”
Card IV: “Feet…monster lying there”
Card V: “Bat”
Card VI: “A fur rug”
Card VII: “Animals upside down sitting
on their heads…pelvis shape”
Card VIII: “Two animals crawling up…
rats”
Card IX: Caped “Deer with horns”
Card X: “A bunch of bugs attacking the pelvic area”
A content analysis of the anatomical responses indicates that three of these reflected the presence of pelvic imagery in her projective consciousness. A further interpretation is that seeing "feet" in Card IV represented a downward displacement of pelvic anxiety.
Having observed these responses, the Rorschach procedure was modified prior to the detailed inquiry. This was done by placing all 10 cards on a couch in front the patient and asking her to put, them in order from those which were "most upsetting" to "least upsetting". This was done because previous experience by the author with rating the level of emotional arousal evoked by the cards has suggested that this modification of the standard Rorschach technique has particular value in body percent research. When they are assembled as a visual unit, essentially it treats the ten inkblots more as an overall gestalt. When the cards are arranged in terms
of their degree of effectual arousal, comparable anxiety levels between adjacent cards in the hierarchy serve as the common link in the affectual chain. It has been found that this rating procedure maximizes the projective "pull' of the inkblots since it facilitates the affectual interaction between the various images that are evoked in consciousness. Moreover, even though it confuses the concept of Rorschach norms, it operationally makes for logical coherence in the associational chain to begin the detailed inquiry with anatomical imagery that is associated with the highest level of anxiety.
In the present instance when this was done, the patient under discussion arranged the series in the following order: X, VIII, IV, V, III, VII, IX, I, II, and VI. It might be noted that Card X was extremely anxiety - provoking to her. When asked rate the anatomical imagery that this inkblot evoked on a scale from zero, to one hundred, with the latter operationally defined as being the "most upsetting thing she ever experienced in her life", she assigned a value of 99 to the card. Thus, the anatomical content pertaining to the pelvis was highly threatening to her.
Starting with this inkblot, the results of the detailed inquiry now follow:
Patient: Well I just see all kinds of...they look like weird bugs of some sort, all attacking...and it almost looks like in the pelvic region and it goes up into the lungs
Doctor: "The pelvic region is where?"
Patient: "Down here pointing to the central red configuration”… this is part of the pelvic region to me...this looks like it."
Doctor: "That's the area in red primary is it? Patient: "Yes...and I always think they are just
attacking …I just...it really bothers me...that
picture really does."
Patient: "These look like rats or something like that (pointing to the red objects on the sides of the inkblot configuration)”.
Doctor: "You are referring to the objects on either side?"
Patient: "Yes"
Doctor: "And what are those rats doing?"
Patient: "Well they are attacking too... it looks like they are going in and either eat you up or something."
Doctor: "What part of the body are they attacking?"
Patient: "Well this is again the pelvic region (pointing to the lower area of the inkblot configuration). A little higher up...to me this is more down here in the pelvic...they are going up a little bit higher."
Doctor: "So the lower area is the pelvic region and they are going up into what part the body?"
Patient: "A little bit higher up into your stomach, up into your lungs kind of."
Patient: "Well this just looks like a monster of some type…it would he an immense bugs or something.
Doctor: "And what is the bug doing?"
Patient: "Well it just looks like it's going...well I don't know...it just feels it is going to do something bad...like it's going to attack again."
Doctor: "What is it going to attack?"
Patient: "Well again...all of these pictures remind me of the poly' Area...I fee is where they are attacking when I look at these picture."
Patient: "That to me looks like a great big bat…. and I don‟t know if it‟s because of radio and the T.V. always think of vampire
Doctor: "Vampire bats?"
Patient: "And sucking blood out of people which I don't really know if they do or not that‟s what bothers me about that."
Doctor: "Where would you be concerned about their sucking blood from?"
Patient: "Well again...you know because of this down here it looks again like it going down to the pelvic region...the bottom end of the bat…you know if you look at in another way it still looks like it‟s part of it again."
Patient: "They look like some strange people of some sort that are banging on a thing that looks like the pelvis and there is blood dripping down on either side which bother me very much."
Doctor: "Where would the blood be coming from and what type of people would they be?
Patient: "Well they just...they...they look like something from outer space not, like something real...like see something unreal and it looks like they're...whatever they're its making this person lose blood somehow and it's dripping down."
Doctor: "And what part of the body is bleeding would you say?"
Patient: "It looks like it's coming from a little bit
higher than the pelvic region”. Doctor: "Like where would you say?" Patient: "Well I say up in the lungs." Card VII:
Patient: "Well this is a little bit different...in a way it looks like two animals are upside down with their heads like this and then again when you look at it this way… it looks like a well… I don‟t known an awful looking person or something… something not real… that again is looking not quite down cause they‟re looking like they‟re just going to attach it like that”.
Patient: "There again I see two very strange creature up there...it almost looks like claws down here (lower green area) and again attacking down to the lower region."
Doctor: "In the lower red area?"
Patient: "yes and these (pointing to the upper green areas) are attacking around the lungs...and these (lower green area) whatever they are...they're awful looking creature they each have a big claw on them."
Doctor: "And where is the claw attacking?"
Patient: "Well that is attacking down into the pelvic region."
Patient: "That just looks like sort of a butterfly and a moth combined...kind of all ragged and rings on it and you can see the feelers un here...it doesn‟t bother me at all that much...I don't like it...as I say it is similar to that vampire bat but it is a different type of thing...it is more on the bug line."
Doctor: "Is this attacking anything?"
Patient: "Well again all of these pictures are shaped to me like the pelvic area and this is why it bothers me that they would be attacking there."
Patient: "Here again they're made to look like some kind of animals un here again of some sort prancing around...and it looks like there is pain down here in the' pelvic area with the red patch hanging in there."
Doctor: "The lower red is the pelvic area?"
Patient: "Yes...whether they're causing it I don't know...but they are up there doing something and it just...you can just see it coming here (pointing to the red colors within the black areas)."
Patient: "Oh this one doesn't bother me too much...it makes me feel like it‟s a big rug.
In reviewing the overall responses on the ten inkblots, it is evident that in the detailed enquiry, when the cards were presented in an anxiety hierarchy, the anatomical responses more clearly depicted psychopathological
body fantasies. The most anxiety laden material was evoked with Card X. In this instance, the patient conjured up in consciousness a fantasy involving the pelvic area as being attacked by various “bugs”. It is suggested that this projective material represented unconscious death anxiety related to the fear that her body was being invaded by cancer tissue. A further suggestion is that the reference to the “lungs” being attacked relate to unconscious anxieties about the secondary spread of her pelvic cancer to the chest.
Her response to Card II warrants additional comments. It represented the only time her conversion symptom of pain was directly projected in the Rorschach. This implied a direct causal relationship in her unconscious fantasy life between the “attacking creatures” symbolizing cancer and her pelvic pain. Thus, this modification of the Rorschach effectively uncovered the psychopathological processes underlying her conversion reaction. It might be noted that these data and this formulation are consistent with Szasz‟s original proposal (Szasz, 1960) that psychosomatic pain arises from the activation of unconscious fantasies involving threat of body assault.
At this time certain other relevant clinical data will be briefly mentioned. One concerned that fact that after testing, initially an interpretative psychotherapeutic approach was attempted employing the Rorschach as an aide. Thus, it was pointed out to the patient in a subsequent interview that many of her responses symbolized unconscious fears that her body was being attacked by cancer tissue. Perhaps predictably enough, considering the intensity which was focused upon the pathologic imagery, she initially chose to reject this interpretation by saying “Well these are just pictures I am looking at like I‟d buy in a store… they don‟t have to do with my pelvic etc.” In this manner she was able to defend against the unconscious cancer fear with only a slight detectable increase in her overt anxiety level.
Two additional clinical observations related to the hypothesis that she has unconscious death anxiety. One pertained to the fact that she reported having occasion‟s anxiety laden dreams in which she imagined herself dying of terminal cancer. The other was that during the course of interviewing under the hypnotic influence of intravenous sodium amytal, she transiently acknowledged having fears that the operation had not removed all the cancer.
The next patient to be described a 57- year old businessman - was initially seen in psychiatric consultation on a surgical ward. The history indicated that he had become hostile, suspicious and uncooperative three days after having corrective surgery to improve the blood supply to his heart. When examined he was diagnosed as suffering from a reactive paranoid psychosis. He had the delusion that toxic fumes were coming through the window poisoning him. There was no neurological psychological evidence of cerebral organicity. His past psychiatric history was negative.
In spite of his psychosis, he was well oriented and liable to participate in psychological testing. Initially he was given the Rorschach and the Holtzman Inkblot Test. Of the 10 Rorschach inkblots, six (Cards I, II, III, VII, VIII, and X) were stated to represent the "heart" and four (Cards IV, V, VI and IX) the "lungs". Similarly, of the 45 Holtzman inkblots, 38 were stated to represent the "heart" and two the "lungs": No non-anatomical responses were projected with either test.
In appraising the psychopathological significance of this dramatic emphasis on anatomical imagery, an attempt was made to relate it to possible anxiety that this particular man might have in regard to his health status. This seemed to be a highly plausible approach since he had previously suffered from severe atherosclerotic heart disease and had just undergone life threatening cardiac surgery. However, remarkably enough, in the interview situation when questioned about such body anxieties he employed the
psychological defense mechanisms of denial and displacement. Thus he denied that he had any fears whatsoever in regard to his health of fear of dying, rather, be -quickly changed the subject emphasizing the fact that he was subjected to unusually demanding pressures at work. In other words, he readily chose to discuss anxieties about, his social role but not his health status. Consequently, it was formulated that there appeared to be a splitting in mental functioning whereby in conscious awareness anxiety was repressed concerning his body concept except for that symbolically implied in the threat of the "toxic fumes" encapsulated in his paranoid delusions, The latter represented a delusional equivalent of his death anxiety.
In considering what psychopathological role such unconscious anxiety could have in his reactive psychosis, attention might be briefly directed to studies where it, has been shown possible to experimentally induce psychotic states in normal subjects by flooding an individual's sensorium with sensory input of a visual or auditory nature (Lipowski,1975). In an analogous manner to these, it is suggested that the flooding of this man's unconscious with death anxiety which he refused to accent in conscious awareness ultimately contribute to his developing a temporary psychotic state. As a follow-up, it might be noted that with appropriate treatment he soon lost his paranoid delusions and developed improved reality testing. However, remarkably enough at no time did he admit that the cardiac illness and subsequent surgery made him afraid of dying?
Rather than being exposed to life threatening illness and surgery, the next patient, to be described suffered from what might he considered primarily an existential type of death anxiety related to the psychological threat associated with aging. She was a 64 year old widow who developed an acute reactive psychotic state just prior to a move away from her rural homestead where she had lived for years. It appeared as though the
move to her signified an important milestone in her when she anticipated leaving the family home to end out her years alone in a new environment She was confronted with the need to adopt a new role plus ultimately face advanced aging decay and eventually her demise.
Interestingly enough, from the existential viewpoint, her psychotic breakdown was initially triggered when she was attending church. According to her daughter, after the religious service she refused to leave the building. She spoke out loudly about imaginary fears of fires and potential accidents happening to her family. In the psychiatric ward, when questioned about her psychotic behavior, she elaborated about her fears in a delusional manner, reporting that certain of her children were dying as a result of tragic accidents. At all times she denied any fears of her own eventual death. It. appeared that when personal anxiety of this nature approached registration in conscious awareness the mental mechanism of projection was activated. Thus, she projected onto her loved ones fears that they – not herself- were drying.
Psychological testing with the Rorschach revealed that her unconscious was literally being flooded with anatomical images in that every response had anatomical connotations. The content of these images is shown below:
Card I: - Spine, lungs
Card II: - Liver, lungs
Card III: - Kidney, lungs
Card IV: - Spine
Card V: - Liver, lungs
Card VI: - Spine, back, neck
Card VII: - Stomach, kidneys
Card VIII: - Kidneys, spine
Card IX: - liver, back, stomach, spine Card X: - Intestines, lungs
After the psychotic phase of her mental disorder cleared, she remained quite anxious, but this time focused her concerns on her own health status. In this connection she complained of sharp pains in the low back and epigastrium. Eventually, with neuroleptic medication and repeated reassurance that there was nothing physically wrong her somatic symptoms disappeared. However, six weeks later when tested as an out-patient she virtually gave the same type of anatomical responses. This time she was not overtly psychotic, nor did she have appreciable psychosomatic symptoms.
To exclude the possibility that memory of the previous testing with the Rorschach might have influenced her second response pattern, she was asked to view the 45 inkblots in the Holtzman series. Out of these she was able to give twenty-two responses, eighteen of which were anatomical. At this stage of her disorder, it was not associated with somatic symptoms, cerebral organicity or any of the other factors which in the literature are considered to account for heightened anatomical awareness. It was therefore hypothesized that this emphasis on somatic content reflected the presence of unconscious anxiety relative to the anticipated decay of her own body associated with her having to adopt her new role as an elderly person away from her homestead.
Prior to the advent of modern psychiatry, it was the philosopher Kierkegaard who observed that while man was given spiritual awareness, he was at the same time was given the consciousness of his own death and decay resulting in the concept of "dread" or what, in this context is referred to as death anxiety. Far him this pervaded all mental functioning and posed a final common pathway for understanding much of man's behavior. It was suggested earlier that this existential path was avoided by men because many mental health professional themselves are made uncomfortable by this line of inquiry plus the inherent difficulties of therapeutic
intervention in this area because death anxiety is ordinarily so strongly repressed.
It appears that there is a need for more penetrating evaluation techniques in this area. In the face of modern evidence regarding the strength of repressive mechanisms acting in this regard (Becker, 1973; Feifel et al., 1973; Weisman, 1972), in many clinical situations where it may be inferred that existential concerns might be present, it would be highly naive to accent the individual‟s simple denial that there is no fear of death. One should examine deeper levels of consciousness especially in patients undergoing life threatening medical or surgical experiences or who are facing psychological peril associated with aging. It might be noted that this view is in sharp disagreement with those who argue that the subject of death has been overworked (Cohen, 1976; Schnaper, 1975; Vaisrub,
1971).
In certain instances, it may be helpful to employ a projective technique such as the Rorschach in appraising death anxiety. It is also possible that this type of existential anxiety might be inadvertently discovered in the course of routine use of the Rorschach. Of course, it is necessary to recognize that it requires careful analysis in interpreting the significance of projected anatomical responses. In this regard, the following classification system is proposed. It is suggested that projected somatic material may he viewed conceptually on a continuum from those responses having primarily sensory feedback implications at one extreme to those having predominantly symbolic connotations at the other. In regard to the former, consistent with Rorschach's origin view (Rorschach, 1951) that certain types of movement responses represented a direct projection of the subject's own proprioceptive sensations. If is hypothesized that many anatomical responses represent a sensory awareness of internal bodily feelings. These may relate to current mind body relationships or his memory engrams of past psychophysiological arousal. An example would be a person who as part of his
emotional arousal senses of increased rate and projects “heart” responses in viewing inkblots. Consistent with this model are investigations linking anatomy responses with body perceptual changes underlying medical symptoms formation (Cassel, 1964, 1965, 1969) and psychosomatic illness (Wagner & Williams, 1975).
The symbolic significance of anatomical responses may he analyzed at several levels. First, a judgment has to be made as to whether or not the rejected material relates to the individual's own body or to those of other people having psychological significance. The latter which will he conceptualized as whether oriented anatomy responses might be illustrated by sympathetic illness imagery (e.g. A woman projecting heart, responses after her husband has suffered from a cardiac illness), sexual fantasy material and aggressive responses related to the impulse to destroy other people (Cassell,1977). The former might be classified as "self-oriented" anatomical responses. An example of these would be mutilated anatomy referring either primarily to the genitalia or symbolically displaced to other body areas relating to that the psychoanalytic literature refers to as castration anxiety. Another would he the death related anatomical responses under present discussion.
In evaluating the latter, it must be emphasized that unlike existing scales (Boyar, 1964; Collett, 1969; Dulok, 1972; Lester et al., 1967; Templer, 1970;) which largely tap conscious attitudes related to dying, the presently outlined approach is based upon fundamental projective principles. It therefore, has particular promise as a clinical aide because it appraises an individual's death anxiety at an unconscious level.
It must be emphasized that this approach is designed to detect death fears in people who at the deeper levels of consciousness are anxious about dying but who are reluctant to consciously face this issue. This was true for those individuals whose case histories were outlined in this report. All denied any
conscious fears of dying. By contrast, if patients are willing to accept into conscious awareness concerns of the nature and openly discuss them, they are much less likely to project anatomical reasons. In other words when the individual is effectively dealing with the underlying existential crisis, there is less unconscious cathexis of the body as a symbol of death.
Just as the skull and cross bones have long symbolized man‟s dread of death, it is hypothesized that certain Rorschach anatomical responses denote such anxieties. Three case histories involving individuals suffering from unconsciousness existential death anxiety were reviewed to illustrate this newly described Rorschach phenomenon. A classification system was outlined to assist in evaluating such responses for their symbolic death content
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PRICE LIST OF SOMATIC INKBLOT SERIES |
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SIS ID |
SIS Version |
Indian Users |
Foreign Users |
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1 |
SIS-I: Card Form |
INR: 13000 |
US $200 |
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2 |
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3 |
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6 |
All Versions |
INR: 60000 |
US $1000 |
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