CHAPTER 3

Theoretical Postulates of Inkblot Tests:

Theoretical Postulates of Inkblot Tests:

The Theory of Perceptanalysis:

Somatic Imagery Theory:

Theory of Body Symbolism:

The Inner Cry for Help:

Hermann Rorschach did not postulate a specific theory with regard to his inkblot technique either for personality evaluation in general or clinical diagnosis (Exner, 1969). His observations concerning the responses led him to a variety of conclusions concerning their specific perceptual determinants of responses, i.e. color, movement and in particular, form. However he did not formulate a theory to his test. His introduction to ‘Psychodiagnostik’ points to the simplicity and intent of his experiment –“the following pages describe the technique of and the results thus far achieved in a psychological experiment which, despite its simplicity, has proved to be of value in research and in general testing. At the outset it must be pointed out that all the results are predominantly empirical. The questions which gave rise to the original experiments of this sort in 1911 were of a different type from those which slowly developed as work progressed. The conclusion drawn therefore, are to be regarded more as observations than as theoretical deductions. The theoretical foundation for the experiment is, for the most part, still quite incomplete. … It must also be noted that there has been constant checking of the observations on normal subjects against the observations of patients and vice versa” (Rorschach, 1951).

In spite of its limitations in terms of theoretical postulations, the Rorschach method offers a procedure through which the individual is induced to reveal his ‘private world’ by telling what he ‘sees’ in the 10 cards upon which he may project his meanings, significance and feelings. This is because they are not socially standardized objects or situations to which must be given culturally prescribed responses. Frank (1939) as many others also believe (Beck, 1937, Klopfer, 1939) that the Rorschach method is essentially a procedure for revealing the personality of the individual but certain clinically relevant material. It is just because a subject is not aware of what he is telling and has no cultural norms behind which to hide him.

As the principal author of the Rorschach test died in 1922 at the age of 37 years, new investigators attempted to extend his basic work in their own ways. This has led to the development of a variety of Rorschach system. Each system represents as an approach to the Rorschach test.

Currently there are six such systems, none of which completely different from the others, or from the Rorschach’s original conceptions. The differences that exist in the present day Rorschach Systems seem to have been precipitated by two factors. First, none of the authors of the six systems, Beck, Klopfer, Hertz, Piotrowski, Rapaport with his colleague Schafer and Exner, had any direct contact with Hermann Rorschach. The second and much more fundamental reason appears to be the general training and background to which each were exposed.

Although there are major differences, there are major agreements too. For example, all those who developed scoring system tended to endorse some form of psychoanalytical theory and accepted many of Rorschach’s original interpretative hypotheses (Exner, 1969). All of these persons developed different systems for Rorschach’s scoring and interpretations. The systems, however, have been heavily drawn from the basic procedure suggested by Hermann Rorschach based on his empirical findings. Among these systems Beck, Klopfer and Exner’s systems are used most frequently depending upon the training the user has received?

However, Zygmut A. Piotrowski (1957) has postulated a theory of Rorschach test known as Perceptanalysis is described below:

The Theory of Perceptanalysis:

Piotrowski (1957) proposed that two different processes require a theoretical explanation: the growth and change of personality on the one hand and the basic concepts and principles of interpreting perceptanalytic responses on the other hand. “The theory of percept analysis is logically different from and independent of the theory of personality. Percept analysis does not throw light on the theory of personality. However, the usefulness of perceptanalysis can be enhanced by the application of sound personality theories to Rorschach data. Perceptanalysis can ascertain whether a trait is present and how strong it is, but it cannot, with its own methods, determine the origin of the traits, ascertain to what degree, if any, the trait is congenital or acquired, organic or psychogenic etc. On the other hand it can be reliably stated that, e.g. person with human movement responses well above the average of their age group felt in their early childhood emotionally rejected by their parents, especially their mothers, but were not physically abused and received adequate care, food and shelter (Piotrowski, 1957). This, like other postulates, widens the comprehensiveness of the Rorschach method, but it does not explain why the human movement responses reveal the traits they do disclose.

The theory of perceptanalysis aims to answer questions like these: “why are human movement responses signs of a basic and not easily modifiable conception of role in life (Piotrowski & Schreiber, 1952), why are positive interpretations of the black color or dark shading associated with intermittent depressive moods, why do responses covering whole blots measure readiness for a prolonged and difficult personal achievement? These and similar other questions are largely unanswered. The large number of concepts involved in Rorschach, however, creates the difficulty in finding adequate empirical referents for complex personality traits” (Piotrowski, 1957).

Dimension to the Evolving Conceptual Model of Somatic Inkblot Series:

The puzzle was first faced in testing psychiatric patients who were diagnosed as suffering from one, or other form of stress triggered disorders. Those, whose medical histories included focal conversion somatic symptoms, would at the early viewing stage project a regionally specific anatomical response. Yet, moments later, when they are responding to the remaining SIS images, they show avoidance or “Projective Repression” of structure, suggestive of the same region (Cassell, 1972).

Thus, it was then recognized that the “time dimension” of regional specific somatic imagery under stress may be highly fluid in consciousness. Psychological defense mechanisms can cause stress linked pathologic images to fluctuate rather rapidly in the intensity with which they are forced in and out of projective awareness. Formulating the role of psychic defenses in the production of a response to inkblots, and their fluctuating influence in shaping emergent imagery sometimes may be particularly problematic. This can sometimes obscure interpretation, especially if only one answer for every card is registered. Consequently in originally modeling the SIS after Wayne Holtzman’s test, Cassell elected not use his scoring approach.

In clinical studies using the SIS, he originally observed that for mentally distressed individuals, often the first projected response merely represented an affect neutral defensive symbol. In such symbolically defended cases, deeper exploration was conducted with the aide of depth probing techniques such as PTSD dream analysis, the study of daytime “Flashbacks”, hypnotherapy, barbiturate induced relaxation etc. These ultimately uncovered more stress related etiological affect charged memories previously hidden by symbolic defenses. Thus studying the overall chain of free associations and projected responses was found to establish more promising etiological clues for psychotherapy. "

Apart from somatic symptoms, the stress triggered disorders have other clinical features involving SIS observed disturbances in imagery (Cassell, 1977). There may be the projection of photographic like realistic representation of stressful past events, or their symbolic representations, as reported in descriptions of threatening dreams, day time visual hallucinations, “flash backs” etc. Moreover, in regard to understanding

Somatic imagery theory proposes that everyone 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 external environmental feedback sources and internal sensations. Relatively discrete mental representations exist for particular somatic regions, which constantly compete for full registration in consciousness. Somatic awareness transiently increases in states of hunger, physical exertion, emotional arousal and sexual excitement. Subsequently, the mental representations in the body fade into the background of consciousness.

Alterations in body perception also occur in physical illness. In the diseased body, pathologic physiologic processes give rise to percepts from the diseased area, which directly or indirectly, enter into awareness. The patient's sensitivity to these depends partially on the pre-existing body concept. Sensations that arise from regions of high priority in the body gestalt are more likely to register than those from more perceptually silent areas. If the sensations are subjectively considered aberrant, the individual must then cognitively evaluate their potential abnormal significance. At this stage, the medical patient experiencing somatic symptoms then makes a kind of lay "diagnosis." Intense pain or gross changes in body function are readily distinguished from normal body processes. However, other alterations such as early stages of disease formation pose problems for subjective interpretation.

The cognitive appraisal of the altered body state is influenced by factors such as age, sex, socioeconomic status and past medical and family history of disease experience. There may be a strong motive, conscious or unconscious, to adopt a sick role to obtain disability compensation. There may also be a stress-induced wish to regress to an infantile, dependent position, and be taken care of by parental figures such as a spouse, grown children, physicians, nurses or nursing home staff.

Interaction between these multiple mind-body (“psychosomatic”) determinants will influence whether or not an individual decides to consult a physician to report subjective experiences. Such "symptoms" reported in the early stages of an initial visit represent verbal communication, containing localized reference to specific organ images within the body gestalt. Their cognitive content reflects altered anatomical awareness associated with the patient's belief that the given region has impaired function. Once professional consultation is obtained, the physician formulates a series of diagnostic hypotheses based on "presenting symptoms", on the nature of the underlying disease processes. Then a former structured medical interview is conducted, with questions designed to uncover the pathological significance of somatic symptom clues. In most instances, an insightful physician will be in a relatively strong position to establish a working diagnosis upon completion of the history.

In this situation, there is no strong need for additional aids in diagnostic interviewing, such as anatomical like projective test techniques. There are, however, some cases when the diagnosis is not clear. Patients may present symptoms, which do not fit into recognizable disease patterns, or there may be major obstacles in communication with the individual. Some patients minimize or deny physical illnesses while others exaggerate them.

Clinical experience, upon which the SIS procedure builds, indicates that persons suffering from stress induced physical disturbances or (“hypochondriac“) conversion reactions, malingering etc will report perceive abnormal anatomical structure on SIS blots. There may be sensitization with anatomy (increase in number of anatomical responses) or repression with avoidance of somatic content. This clinical use of content analysis follows the interpretation principles described by Schafer (Schafer, 1954, 1960).

When the responder projects the response "sick stomach," it may indicate a concern about individuals own health or that of the loved one. Alternatively in a more physiologic fashion, it may signify a deeper level of body awareness involving the stomach. This is consistent with Hermann Rorschach's believe that certain anatomical responses may be a projection of kinesthetic sensations in the musculature.

There are a variety of techniques, which can be used to bring psychological conflicts to the surface. One example is dream analysis. Other approaches involve art work, or sand tray analysis with children. Although "normal" perceptions reflect good reality contact, an individual's perception is never 100% congruent with objective reality, or conceptually subjective meanings. Both the memory of visualization of the real world and dreams are contaminated by personal, cognitive and affective percepts. Such internalized imagery may often elude both traditional structured interviews and standardized psychological tests. The SIS moves into these hard-to-tap areas through the use of hypnotic electronic technique. These provide a window for examining inter-personal and psychic space, in a way not previously possible.

By assessing an individual's responses, and associations to them, much can be learned about the person's innermost thoughts and feelings. What is seen or imagined in semi-ambiguous inkblots reveals his deeper layer of self-perception. It is hoped that these evolving technique may be applied by investigators of inner psychic space leading to the creation of new body-mind-spiritual theory. At its present stage, the various forms of the SIS have been found helpful as an aide to enable professional to empathize more sensitively with the suffering individual's "inner cry." Previously, their suffering was more likely hidden because of defensive mental mechanisms. Many existing techniques employed today are highly time consuming, not particularly cost-effective. Perhaps most important of all, they do not readily provide a transparent window into the inner world.

Interest in the symbolic significance of the human body can be traced back to the very dawn of civilization (Wentinck, 1972). Indeed, ancient wall paintings and stone carvings evidence preoccupation with this subject. These distinguish Homo sapiens from less symbolically able species. Throughout history, pictorial representations of the body have been a central theme of artistic expression of humanity's search for identity. Philosophically, such representations are an attempt to integrate mental and physical phenomenon rather than to isolate or reduce them, as in Cartesian mind-body dualism.

When someone projects onto an inkblot the response "sick stomach", it may indicate a concern or focus on that organ in one-self or another person. It also might indicate some association or deeper symbolization involving the stomach. An organic or functional disorder in that organ system is consistent with Rorschach's view that certain anatomy responses may be a projection of kinesthetic sensation in the musculature (Rorschach, 1951). Freud, and later Alexander and French, described how gastrointestinal dysfunction or distress can be a manifestation of underlying psychological conflict which is below conscious awareness.

Projective techniques geared specifically to body imagery and organ function assesses both organic and functional disorders, real or imagined. Roy Schafer, a psychoanalyst, advocated a content analysis approach (Schafer 1954, 1960). More recently, content analysis has been reviewed in Aronow and Reznikoff's book "Rorschach Content Interpretation" (1973).

Qualitative content analysis assesses the individual's imaginable mode of information processing. It taps the same inner perceptual field as dream imagery. This occurs on a continuum from pictorial recall to pictorial metaphor. Pictorial recall is visualized objective reality, rational and realistic. Pictorial metaphor is a complex concept which is highly individualized, consisting of subjective associations of past experiences, interpretation of present realities and future expectations along with their meaning. While "normal" perception matches reality, it is never 100% congruent with objective fact. An example is the relative unreliability of some eyewitness accounts. Memory and dreams are contaminated by personal cognitive and affective percepts. These dynamics often elude both structured interview and a battery of standardized psychological tests. They are more readily understood through extensive symbolic analysis.

Clinicians worldwide have heard the cry for help in a variety of ways. These range from abused children who escape stress through Dissociative Disorders to victims of catastrophe or war, who suffer from post-traumatic stress disorders. Other manifestations include ongoing frustrations in their life situations and in affective disorders or abnormal behavior.

Some cry for help through their bodies, with Somatoform disorders. All these are diagnosable by DSM or ICD criteria through use of definition and symptom checklists. Underlying conflicts can also be manifested in subtle, more complex, and less dramatic ways. Physical symptoms, such as functional disorders, hypersensitivity of an organ system, or pain all in themselves may represent a form of a cry for help. There are daily examples of this somato-psychic interaction in such expressions as "it's a real pain in the neck" (or elsewhere), "my heart was pounding" (broken, bleeding, or heavy), "what a headache", "he's a hothead", etc.

For physicians, therapists and researchers, the body, its organ systems and its perceived functions are "doorways to the mind." By observing and assessing how people perceive or misperceive body and organ function, much can be learned about their innermost thoughts and feelings. What they see in ambiguous and semi-ambiguous inkblots shows how they see themselves, the quality of their life and lifestyle, their adjustment to conflict, their coping skills and their view of the reality of life.

The Somatic Inkblot Series can help therapists more sensitively "hear" a suffering individual's cry for help, the "inner cry" that is not only hidden from others, but often hidden from one's own conscious awareness as well. This is the "magic"; the unique and distinguishing feature of projective testing.

While the SIS uses somatic inkblots that involve body and organ imagery, they have identified a variety of personal problems and mental disorders also. As stated above, everyday conversations are replete with examples of the mind-body connection, such as "broken heart" for depression or grief; "stuck in my craw", "eating at my gut", "pain in the neck," or "what a headache" are used for anger or frustration; "butterflies in my stomach" or "scared shitless" are used for fear or panic, to name just a few.

Since projective tests are not based on verbal communication, they more effectively penetrate a person's "outer shell" of defenses and surface behaviors. Unlike personality and intelligence tests, projective tests do not require reading questions or manuals, so they more directly access mental processes. They use the language of dreams, visual imagery and symbolic thought, the most basic forms of thinking and expression. Projective tests speak the language of repression and bring whatever is buried in the mind closer to consciousness, so it is accessible for processing.

By developing a practiced eye and ear for this imagery, therapists can more directly share the perceptual world of their patients with less interference, and fewer variables than in structured interviews or so-called "paper and pencil tests." If, as the saying goes, "a picture is worth a thousand words," inkblots are picture recognition tests, and therefore are potentially more powerful than verbal interviews and tests. Therapists willing to more directly know and experience the patient's psychic pain will be rewarded with clearer understanding of the psycho-dynamics involved, and therefore be able to provide more effective therapy.

Applications of Cassell’s Theory:

In the early 1980’s Cassell developed a new Rorschach content based interview for psychotherapy growing out of clinical work involving various diagnostic categories. The theoretical background for this was especially brought into sharp focus in working with those suffering from mental disorders triggered by stressful life events, which had stimulated high neurophysiologic arousal.

Originally, because of the practical feasibility of concurrently monitoring heart rate during projective testing, and the relative ease of designing anatomical inkblots symbolically resembling the heart, the initial SIS included inkblot structure symbolizing the heart (Cassell, 1969). In the original studies, it was found that subjects with somatic symptoms such as “palpitations”, “heart discomfort” fell statistically at the extremes. They either projected more cardiac responses or avoided identifying the suggestive embedded anatomical content.

In the early years, similar studies were being conducted using as an index of cardiac awareness, a subject’s ability to recognize visual stimuli during tachistoscopic presentation (Cassell & DuBoczy, 1967). The experimental series presented brief exposures of medical textbook illustrations depicting the heart. Analysis of the data revealed a similar statistical pattern as in the SIS project. What is anticipated in this century are studies in which an individual views a (“threatening”) somatic inkblot and simultaneously has brain function monitored by 21st century technology? Until this occurs we will not have a solid scientific basis for our theory.

The Role of Familiarity and Sensory Feedback in Anatomy Projection:

Familiarity with anatomy is a strong determinate regarding the recognition and subsequent projection of anatomical responses. In SIS studies, it is important for the investigator to eliminate this factor as much as possible. Anatomical sophisticated people, such as those in the health professions, need to be assessed separately in data analysis. However, if an individual who is highly familiar with anatomy fails to recognize such content in a highly structured SIS inkblot, it may be inferred that some mental defense system is actively blocking the process.

Another example in connection with the “Familiarity factor” relates to the individual’s current physical state apart, from stress linked somatic symptoms. If the individual is in a state of neurophysiologic arousal, either from physical activity or psychological stress, than sensory feedback mechanisms become operational.

Two studies relative to this are worth mentioning. The first, involving arousal induced by exercise involved assessing the immediate feedback of cardiovascular sensations. In this project, healthy college students were assigned randomly to one of two matching groups. One was tested with the SIS, while sitting on a bicycle without pedaling. The other exercised to the cardiovascular arousal stage of advanced heart rate. It was found that significantly more heart responses were projected by the exercising group.

The second study involved psycho physiologic arousal experienced by patients suffering from Schizophrenic Disorder during admission to a psychiatric hospital. It was found that those with higher heart rates, not only projected more heart responses, that as well in drawing internal organs, they tended to represent the cardiac region as larger. Thus not only were they more focused on the heart, the increased sensory feedback made it feels larger.

In clinical populations two additional influences can alter regional somatic awareness. In those suffering from a severe mental disorder, such as the schizophrenic group mentioned above, there may be psychotropic drug induced side effects. For example, some antipsychotic medications can produce extra pyramidal muscle symptoms, thereby altering the focusing of attention within the body gestalt. Similar regional distortions in awareness may be present in patients with medical illness. For example, increased cardiovascular feedback from congestive heart failure and untreated hyperthyroidism individuals with tachycardia can project more anatomical symbolic heart responses in viewing inkblot stimuli.

When the implications of these overall influences were considered conceptually, an initial step was made to formulate a theoretical model. It was postulated, that an individual’s subjective mental representation of the heart had two fundamental psychological dimensions: the one involving cognitive characteristics, such as physical shape, size, the individual’s hypochondriacal health perspective etc., and the other, the subjective affect linkage of such somatic imagery. It was also postulated that such affect was partly controlled by psychological defenses influencing opposing mental forces of “Sensitization Repression” and consequently the extent that the organ image impinged upon projective awareness. In terms of evolution, the most primitive underlying principle affecting regional body awareness concerned sensory feedback mechanisms. Relative to these genetically determined biological factors; the greater the feedback of introceptive sensations from an organ system, the more attention would be drawn to that region’s symbolic mental representation within the body gestalt. Finally in regard to extending this conceptual model, it was expected that similar mechanisms might apply to perception of the total exterior “Body Image” or “Human” inkblot responses.

Sex Differences in Inkblot Psychophysiology:

The degree that somatic imagery impinges upon projective awareness is influenced by the relative extent to which the degree of physiologic activity in the organ system produced peripheral nervous system sensory feedback. Input from this is then subjectively perceived in the aroused sensory cortical centers as “sensations”. Related to this “Fight or flight” reactions, a psychopharmacological study using a stimulating dose caffeine found that in males, but not females, arousal is associated with a shift in body awareness to the right side (Cassell & Hemingway,1970). This unpredicted finding also needed to be incorporated into the evolving theory. For example, it was expected that this sex based mechanism would also operate during projective responding to inkblot stimuli. In viewing anxiety affect linked blots, physiologically aroused males likely have as a result, a similarly based shift to right focusing.

The subsequent literature in this field is relevant. Rhawn Joseph, in a series of scientific articles in the 1980’s theorized about the existence of sex differences in human brain function. Consistent with this line of thought, in 2006 Larry Cahill and Lisa Kilpatrick at the University of California in Irvine using Positron emission Tomography (PET) scans found that the amygdala behaves very differently in males and females. In men the right amygdala is more active and show more connections with other regions of the brain, even when there is no outside stimulation. Conversely, in women, the left amygdala is more connected with different regions of the brain. In addition, the regions of the brain with which the amygdala communicates, while a subject is at rest are different in men and women. Thus not only was there a difference as to which hemisphere’s amygdala was more active, but also that the regions that the amygdala “talked” with were quite different.

There are certain general implications to these findings, some of which may be incorporated into a conceptual model of SIS inkblot perception. Many brain regions communicating with the amygdala in men are engaged with and responding to the external environment. For example, the visual cortex is responsible for visualization of the outer world, including inkblot stimuli, while the striatum coordinates motor actions. Conversely, many regions connected to the left hemisphere in women (e.g. the insular cortex and the hypothalamus) receive strong input from the sensors from the body interior and control psychophysiologic internal processes, only alterable consciously by Yoga experts.

SIS Imagery and Dreams:

During psychophysiological arousal, this feedback process can give rise to real and symbolic somatic imagery during dreaming. A dreamer with a full bladder sending sensations to the brain will often experience scenes related to the need to urinate. Similarly, tensions in the reproductive structures can stimulate sexual imagery and related physical responses. If these feedback mechanisms were activated under laboratory controlled experimental conditions in associations with projective testing, it might be expected that similar somatic responses would be projected.

Against this conceptual background, apart from cognitive “familiarity”, affect linkage influences the intensity that heart percepts compete for registration in body gestalt awareness. Affect linked processes can then either heighten awareness or through neural inhibition, block organ specific imagery from registering in full consciousness. Evidence of this emotion based phenomenon is observed clinically in the mental disorders by “thought blocking”, “amnesic episodes, “conversion reactions” etc. Two clinical approaches that examine this theoretical consideration were completed. One involved the creation of a reduced state of viewing arousal, by inducing hypnotic relaxation; the other involved the use of sedating medication (Interveneous barbiturates). These approaches led to observations, that reducing anxiety/threat can free up the release of previously inhibited somatic imagery. Such clinical insights played an important role when SIS-II Video version was designed.

PTSD Imagery Fluctuates Rapidly:

Subsequently on the basis of puzzling SIS projective test results, a decision was made to add a temporal dimension to the evolving conceptual model. The puzzle was first faced in testing psychiatric patients who were diagnosed as suffering from one, or other form of stress triggered disorders. Those, whose medical histories included focal conversion somatic symptoms, would at the early viewing stage project a regionally specific anatomical response. Yet, moments later, when they are responding to the remaining SIS images, they show avoidance or “Projective Repression” of structure, suggestive of the same region (Cassell, 1972).

Thus, it was then recognized that the “time dimension” of regional specific somatic imagery under stress may be highly fluid in consciousness. Psychological defense mechanisms can cause stress linked pathologic images to fluctuate rather rapidly in the intensity with which they are forced in and out of projective awareness.

Apart from somatic symptoms, the stress triggered disorders have other clinical features involving SIS observed disturbances in imagery (Cassell, 1977). There may be the projection of photographic like realistic representation of stressful past events, or their symbolic representations, as reported in descriptions of threatening dreams, day time visual hallucinations, “flash backs” etc. Moreover, in regard to understanding the significance of visual hallucinations, unrelated to physical toxicity or disease states, stressful scenes projected may arise from the same psychological or spiritual symbolic mental image stream as projected inkblot responses.

One practical application of this conceptual model focuses on the cognitive content of projected images, as well as their relative affective charge. The second incorporates the responder’s own subjective rating of the responses affect arising from the brain’s more primitive neural circuitry. This additional information is obtained by asking the responder to select the three “most liked” and then the three “least liked” ones.

In theory, the former are considered to reflect positive emotional linkage of imagery. As indicated earlier, in the detailed enquiry, the subject matter of these responses is initially introduced to reduce test anxiety. As will be illustrated in subsequent case histories in this book, the later are more likely to relate to unresolved stressful memories. Sometimes this symbolically, hidden material is outside the subject’s immediate recollection but when it is noted in the detailed enquiry by the examiner, it can assist the psychotherapist in treatment planning. Of course, not completing the detailed enquiry in order of presentation, may undermines to a degree applying normative data, the trade off in therapeutic power, often proves worthwhile in custom designing treatment planning.

Another application which was previously mentioned for psychologically more stable individuals is to permit them to view the SIS-II electronic version at home, prior to bedtime. It has been found that the evening residual from this viewing procedure can stimulate dreams, which reflect previously hidden issues that need psychotherapeutic resolution. When this variation technique is used, it is essential for the therapist to interview the first thing in the following morning when the imagery and affect of SIS stimulated dream is clear in memory.

Genetic Determinants of SIS Projection:

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 the 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 cognitions.

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 voice, 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 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 the 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. Relative to this discussion, the ability to empathize is impaired in psychiatric/neurological conditions. On the positive side, some individuals can be taught empathetic skills, and this may prove to be one helpful function of psychotherapy. 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 empathetically 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 in 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 seeking 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 flat worms loaded with social isolation gene) 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 (Cassell, 2010).

Applying this Model to the Rorschach and Holtzman Procedures:

This theory enabled me to rethink test administration in the early 1980’s for both the Rorschach and Holtzman tests. The testing interview room is specifically staged. The administrator has a table on which all the cards are placed face up. When the subject enters the consultation room, these are initially viewed as a total gestalt.

Then the subject is asked to rate the responses, first for the “Three most liked plates”. Next, the interviewer asks questions to determine the reasons for the choice, as well as what emotions are aroused by the viewing process. After completing each, the card is then placed face down on the table. Upon completion of this test anxiety reducing phase, the process is then repeated with the “Three most dislike ones”. Finally the examiner completes the testing using the standard numerical order of the remaining inkblots, while constantly monitoring the verbal and nonverbal affect linkage of all the rest.

Afterwards, all are placed face up for a review as a gestalt and the examiner asks: “Do any of these remind you of your dreams?” This is an important question since the SIS has been found in many stresses triggered clinical situations, to tap into the same memory stream, as affect charged “nightmares”. Moreover, in retest situations, if progress is made in treatment, there is a parallel improvement in him direct and symbolic content of the projected inkblot imagery.

Sometimes, examiners may choose to first administer the Rorschach and Holtzman tests in a standardized traditional fashion, before using the above inkblot structured psychotherapeutic interview process.

Influence of Culture on Inkblot perception:

Dana (2000) compared Exner’s normative data of North Americans with European and South American subjects and found marked differences on some important variables. For example, texture response is typically zero in European subjects (a European would express it only when it reaches the level of a craving for closeness) and there are fewer "good form" responses in comparison to the North American norms. Form is most often the only determinant perceived by European subjects, while Color is less frequent than in American subjects. The European subjects see more of Color-Form responses than Form-Color responses in comparison to North American subjects.

The differences in Form quality are attributable to purely cultural aspects: different cultures will exhibit different "common" objects (e.g. French subjects often see a chameleon on card VIII, which is normally considered as an "unusual" response, as opposed to Cats and Dogs by Scandinavians. Christmas Elves on card II and Musical Instrument on card VI is a popular response for Japanese subjects (Weiner, 2003).

Form quality, popular content responses and locations are the only coded variables in the Exner systems that are based on frequency of occurrence, and thus immediately subject to cultural influences; therefore, cultural-dependent interpretation of test data may not necessarily need to extend beyond these components (Weiner,2003). Similarly total numbers of responses are comparatively low among Indian subjects than North America. Army personnel give significantly low number of Responses in comparison of other Indian norms (Dubey, 1982).

Similarly, we have noticed different responses on Somatic Inkblot Images by North American subjects and Indian subjects. Dancing lady and Apple are popular response on image A7 in North Americans whereas two Snakes along with Dancing lady and Apple are commonly perception by subjects in India. Alaskan subjects rarely project a Snakes response in in Alaska. With regard to projection of sexual responses for A 25, A27, and B18 North American subjects gave a higher number of responses than those living in India. It might be inferred that less were seen by Indians because of cultural impact and religious practices. Eve with an Apple is the common response on image A7 in North Americans. Similarly it is often perceived by Indians educated in Christian/English Schools in contrast with other Indian subjects. Similar findings have also been reported in various case studies published in several issues of SIS Journal of Projective Psych. & Mental Health.

Weiner (2003) has also advised when possible, to administer projective testing in the subject's native language. Test responses should also not be translated into another language prior to analysis except possibly by a clinician mastering both languages. It is hoped that Anthropologist will follow up on these observations.