Intake & Presenting Somatic Complaint
In this case history study, the SIS Video, Rorschach Inkblot Test and figure drawing tests were administered to a teenage girl who was admitted to a psychiatric hospital in Boston for treatment of major depression and dissociative disorder. She had history of suicidal ideation and self-mutilation of her left wrist and forearm. The relaxing instructions in the video and the hypnotically present healing flowers may have facilitated neural extinction of the terrifying hallucinations intruding upon her consciousness. The figure drawing and content analysis of SIS and Rorschach may provide useful aids to supplement standardized clinical interviewing techniques. The case has been discussed in detail (Cassell, Schaeck and Mohn, 2002).The study of hallucinatory phenomenon has been long proven of interest. If there is a common clinical bias in evaluating hallucinations, it is the assumption that these perceptual disturbances are evidence of abnormalities in brain chemistry. There is a great deal of supporting evidence for this viewpoint, especially in those with disease of the central nervous system or toxic condition
The Projective Stimulus & Subconscious Projection
On the second day of hospitalization, she was administered the video version of the SIS. The image that she rated as most threatening was B1. A transcript of the detailed enquiry is as follows:
S: No. (This projective response incorporates an image of a ‘claw’ which in disguised form symbolizes the hallucinatory figure’s knife.)”
Clinician Decoding & Subconscious Dynamics
Prior to admission, the patient (her fictitious name S) had experienced severe suicidal ideation with plans involving a variety of suicidal behaviours such as overdosing, slitting her throat and electrocution. Her usual behaviour involved self-mutilation of her left wrist and forearm. While she had experienced suicidal ideation from the time she was severely abused by the violent biological father, her pattern of mutilation had only started after she had been removed from high school seven months back by her mother and stepfather. Even though she had been made to do homeschool, she retained communication with a teacher who had been especially supportive of her interests in drama and writing. When she revealed to him her suicidal thoughts, he contacted mental health services who referred her for hospitalization. Her parents initially refused to accept the fact that she hallucinated and was a danger to herself.
During the initial psychiatric evaluation, she reported that she had previously drawn a coloured representation of a reoccurring violent visual hallucination. This was a threatening man with a knife in his hand. Her representation of the figure revealed that he had cut his wrists. Red blood poured from the wounds. When asked to recall who he reminded her of, she said that it reminded her of her abusive biological father. Upon detailed questioning about her drawing, she told the interviewer that the eyes resemble ‘mine’.
She was selected for this i
Treatment Intervention & Longitudinal Recovery
Intervention Strategy: SIT diagnostic assessment followed by cognitive and psychodynamic therapeutic intervention.
Longitudinal Outcome: Resolution of acute somatic complaints and successful integration of affective boundaries.
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