INDIAN JOURNAL OF CLINICAL PSYCHOLOGY

Editorial Bord i

Journal & Executive Committee Members ii-iii

Volume 37, Number 1 Instruction to Authors iv-vii March 2010 Editorial: Evolution, Microgenesis and Neuropsychological 1-6 Rehabilitation: S.P. K. Jena

H.N. Murthy Oration Award 2009: 7-18 Deriving Real World Solutions : The Art and Science of Aviation Psychology : Catherine Joseph

Emotional Intelligence, Impulsivity and Suicidal Ideation of 19-29 College Students: Nishi Mishra, Sangeeta Yadav, V. K. Moudgil, Updesh Kumar

Standardization of Tests of Visuo Construction and Mental Rotation: 30-37 Himani Kashyap, Shobini L. Rao, Keshav Kumar J., B., Indira Devi

Narratives of Wives Living with Persons with Alcohol Dependence– 38-46 Why Do they Stay in Violent Marital Relationships?: Mahima Nayar, D. Muralidhar, M. N. Vranda, Pratima Murthy, B.N. Gangadhar, A. Jagadish

Media-portrayed Idealized Images, Body Dissatisfaction and 47-60 Negative Affect in College Women Kanika Aggarwal Khandelwal

Stress and Coping Styles of Pilots in Indian Civil Aviation-- An 61-69 Exploratory Study: Meena Hariharan, K.Shantha Nanda Prasad, Sunayana Swain

Cultural Factors in Clinical Assessmernt: The Indian Perspective 70-80 S.Venkatesan

81-82 Editor Book Review S. P. K. Jena, Ph. D. S. P. K. Jena

RNI RN 26039/74

Official Publication of Indian Association of Clinical Psychologists www.iacp.info INDIAN JOURNAL OF CLINICAL PSYCHOLOGY ______Volume 37 March 2010 No. 1

Editor: S. P. K. Jena, Ph. D.

Editorial Board A. T. Beck, Ph. D., U. S. A. M. K. Mondal, Ph. D., Delhi Adarsh Kohli, Ph. D., Chandigarh Malavika Kapur, Ph. D., Bangalore Akbar Husain, Ph. D., Malayasia Mallika Banerjee, Ph. D., Kolkata Akila Kesavan, Ph. D., Bengaluru Manju Mehta, Ph. D., New Delhi Alka Nizamie, Ph. D., Ranchi Manoj Sharma, Ph. D., Bangalore Amool. R. Singh, Ph. D., Ranchi Manoranjan Sahay, Ph. D., Delhi B. P. Mishra, Ph. D., Ludhiana Masroor Jahan, Ph. D., Ranchi B. L. Dubey, Ph. D., Chandigarh N. R. Mrinal, Ph. D., Nagpur C. R. Mukundan, Ph. D., Banglore Namita Khanna, Ph. D., Australia D. Dhanpal, Ph. D., Coimbatore P. K. Chattopadhyay, Ph. D., Kolkata D. Sahoo, Ph. D., Bhubaneswar P. K. Chakraborty , Ph. D., Ranchi D. K. Kenswar, Ph. D., Ranchi P. T. Sasi, Ph. D., Trissur D. Pershad, Ph. D., Chandigarh R. G. Sharma, Ph. D., Varanasi Dalip R. Patel, Ph. D., U.S.A. Rakesh Kumar, Ph. D., Agra Debdulal Duttaroy, Kolkata Ritu N. Sharma, Ph. D., Chandigarh Dharitri Ramaprashad, Ph. D., Bangalore S. Dash, Ph. D., Canada Dwarka Pershad, Ph. D., Chandigarh S. Haque, M. D., Ranchi F. M. Sahoo, Bhubaneswar S. C. Gupta, Ph. D., Lucknow G. G. Prabhu, Ph. D., Mysore S. E. Hussain, Ph. D., Muzaffarpur Geetika Tankha, Ph. D. , Jaipur S. K.Verma, Ph. D., Chandigarh Honey Vahali Oberoi, Ph. D., Delhi S. R. Khan, Ph. D., Jammu Jamuna Rajan, Ph. D., Bangalore S. S. Nathawat, Ph. D., Jaipur N. K. Chadha , Ph. D., Delhi Shobini L. Rao, Ph. D., Bangalore K. Geerish, Ph. D., Thiruvanantapuram Subodh K. Sinha, Ph. D., Ranchi K. B. Kumar, Ph. D., Secunderabd Suprakash Choudhury, Ph. D., Ranchi K. Dutt, Ph. D., Lucknow Surya Gupta, Ph. D., Gurgaon K. P. Sreedhar, Ph. D., Thiruvanantapuram T. B. Singh, Ph. D., New Delhi K. Rangaswami, Ph. D., Secunderabd Thomas Kishore, Ph. D., Kolkata Kalpana Srivastava, Ph. D., Pune T.S. Sathyanarayana Rao, MD, Mysore Kiran Rao, Ph. D., Bangalore Updesh Kumar, Delhi L. Sam S. Manickam, Ph. D., Mysore Vibha Sharma, Ph. D., Delhi L. N. Suman, Ph. D., Bangalore Y. S. Vagrecha, Ph. D., Sagar

i Journal Committee S. P. K. Jena, Ph. D. (Convenor) S. Venkatesan , Ph. D. (Co-convenor) All India Institute of Speech & Hearing .University of Delhi, South Campus, New Delhi Mysore

L. S. S. Manickam Ph.D. (Ex-Officio) Honey Oberoi Vahali, Ph. D. ,University of JSS Medical College Hospital, Mysore Delhi, Delhi

K.B.Kumar Masroor Jahan, Ph. D. Sweekar Institute of Rehabilitation Sciences, Ranchi Institute of Psychiatry and Allied Sciences, Hyderabad Ranchi

Executive Council

President President-Elect Malavika Kapur, Ph. D. Manju Mehta, Ph.D. A-3, Burnton Rustumji Apartments All India Institute of Medical Sciences, New 21 Brunton Road, Bengaluru Delhi,e-mail: [email protected] e-mail: [email protected]

Immdeiate Past President Treasurer Tej Bahdur Singh, Ph. D. Adarsh Kohli, Ph. D. Institute of Human Behaviour and Applied Sciencs, Post-graduate Institute of Medical Education Delhi, e-mail: tejbsingh [email protected] and Research, Chandigarh Council Members: West Zone Secretary V. C. George, Ph.D., Miraj L.S.S Manickam, Ph.D. e-mail: [email protected] JSS Medical College Hospital, Mysore Radhika Bappat, Pune e-mail: [email protected] e-mail: [email protected]

Joint Secretary Council Members: North Zone Basavarajappa, Ph. D. Anand Pratap Singh, Delhi PG Department of Psychology e-mail: [email protected] Mysore University, Myrore, Dherendra Kumar, Delhi e-mail: [email protected] e-mail: [email protected] Immediate Past Secretary K. Geereesh Ph.D. Council Members: South Zone N. Suresh Kumar, Madurai Council Members: All India e-mail: [email protected] Rakesh Kumar, Ph.D. Agra Venkata Subbaiah, C., Hyderabad e-mail: [email protected] e-mail: [email protected] Sanjukta das, Ph.D. Kolkata e-mail: [email protected] President’s Nominees Poornima Bhola, Ph. D., Bangalore Council Members: East Zone e-mail: [email protected] Kaptan Singh Senegar, Ph. D., Ranchi Akila Keshavan, Ph.D., Bangaluru. senegar_dr.ks_ [email protected] [email protected] Tilottama Mukherjee Ph.D., Kolkata e-mail: [email protected]

ii Instruction for Authors

Submission of a manuscript to IJCP implies that all guiding readers regarding their characteristics and authors have read and agreed to the following potential utility. They must be brief summary of the conditions for publication: work, offering opinions. Reports must contain the complete bibliographic reference for the book such as (a) Title, (b) Name of the author(s), (c) Name of the 1. Ethical Standards publisher, (d) Place of publication and (e) Total pages Any experimental research that is reported in IJCP at the beginning and it should close with the name(s) has been performed with the approval of an and institutional affiliation(s) of the author(s) of the appropriate ethics committee or the author should review. make a statement that (s)he has maintained necessary 8. Manuscript Preparation ethical standards while conducting research. A At least 3 sets of hard copies should be submitted statement to this effect must appear in the Methods along with a soft copy.(The first copy should be section of the manuscript. printed on one side and the other two back to back). All manuscripts should be prepared in Microsoft Word 2. Original Articles format, in Times New Roman, font size 12, typed in Original articles must report research work which has double space and have generous margins. In case of not been published and is not under consideration for experimental work, the author(s) must specify the publication elsewhere. The length of the original article purpose of the study. The text of observational and should not exceed 5000 words. experimental articles should usually be divided into the following sections with the headings, such as: Introduction, Methods, Results, and Discussion to 3. Review Articles clarify their content. All pages of the manuscript should Reviews are usually commissioned by the editor. But be numbered consecutively at the right corner of the unsolicited reviews will also be considered. The length page. The Title Page (Page 1 should contain title of of the review article should not exceed 5000 words. the article, name(s) of the corresponding author(s) telephone, and e-mail address if any, of the author 4. Brief Communications responsible for correspondence. It should also contain Original, but shorter, manuscripts, with preliminary the source(s) of support if any received in the form of results or results of immediate relevance will be grants, equipment, drugs, or all of these including the considered in this section with a word limit of 1000 word count. The word count should include text of words (with a maximum of 10 references and no more the article only (excluding abstract, acknowledgments, than one table or one figure). They must be figure legends, and references). This page should also accompanied by a suitable abstract and key words. indicate the number of tables and figures used in the article. Page 2, should contain only title of the article, abstract and keywords (up to 6). Page 3 onwards 5. Case Reports should contain the actual article beginning with the Case reports of interesting cases should not exceed Title and ending with References. 1500 words and should contain references like any other scientific article. 9. Conflict of Interest Authors are required to complete a declaration of 6. Letter to Editor competing interests. It should be included on a separate Scientific letters either with reference to an article page or pages immediately following the title page. published recently in the journal or on a topic of Where an author gives no competing interests, the contemporary interest will be considered for listing will read ‘The author(s) declare that they have publication. no competing interests’. Authors should describe the role of the study sponsor(s), if any, in study design; in the collection, analysis, and interpretation of data; 7. Book Review in the writing of the report; and in the decision to These are critical reviews of recently published books, submit the report for publication.

iii 10. Authors’ contributions 13. Method In order to give appropriate credit to each author of a Describe the source population and the selection paper, the individual contributions of authors to the criteria for study participants. Identify the methods, manuscript should be specified in this section. An apparatus, and procedures in sufficient detail to allow “author” is generally considered to be someone who other workers to reproduce the results. Authors has made substantive intellectual contributions to a submitting review manuscripts should describe the published study. To qualify as an author one should methods used for locating, selecting, extracting, and (1) have made substantial contributions to conception synthesizing data. Describe statistical methods with and design, or acquisition of data, or analysis and enough detail to enable a knowledgeable reader with interpretation of data; (2) have been involved in drafting access to the original data to verify the reported results. the manuscript or revising it critically for important When possible, quantify findings and present them intellectual content; and (3) have given final approval with appropriate indicators of measurement error or of the version to be published. Authors should meet uncertainty (such as confidence intervals). Specify all conditions (1, 2, and 3). Each author should have the computer software used. participated sufficiently in the work to take public responsibility for appropriate portions of the content. 14. Results Acquisition of funding, collection of data, or general Authors should avoid repeating in the text all the data supervision of the research group, alone, does not provided in the tables or illustrations and use graphs justify authorship. One or more authors should serve as “guarantors,” i.e. persons who take responsibility as an alternative to tables with many entries or duplicate for the integrity of the work as a whole, from inception data in graphs and tables. This section should focus to published article. on scientifically appropriate, analyses of the salient data by variables such as age and sex should be included. 11. Acknowledgements Please acknowledge anyone who contributed towards 15. Discussion the study by making substantial contributions to This section should emphasize the new and important conception, design, acquisition of data, or analysis aspects of the study and the conclusions that follow and interpretation of data, or who was involved in from them. For experimental studies it is useful to drafting the manuscript or revising it critically for begin the discussion by summarizing briefly the main important intellectual content, but who does not meet findings, then explore possible mechanisms or the criteria for authorship. Please list the source(s) of explanations for these findings. Compare and contrast funding for the study, for each author, and for the the results with other relevant studies, state the manuscript preparation in the acknowledgements limitations of the study, and explore the implications section. of the findings for future research and clinical practice.

12. Abstract and keywords 16. References A structured abstract should accompany observational References should be written according to the guidelines and experimental manuscripts. It should contain the of Publication Manual of the American Psychological aims, methods, results, and conclusions briefly and be Association (4th ed.). Some examples are given below: limited to 250 words only. From the abstract, a reader Personal communications should be cited when should be able to make out what the content of the absolutely necessary (in the text) but should not be article. Hence it requires special attention of the author. included in the list of references. In the reference section, list all authors’ names when there are six or Other kinds of manuscripts should have unstructured fewer; when there are seven or more, list the first six abstract of about a 100 words. Following the abstract, and add et al. Particular care be taken for punctuation the authors should also provide 3 to 5 key words or and the spelling of authors names, the spelling in the short phrases that capture the main topics of the article. text and the year should be consistent with that in the references. Reference, which has not been cited in the 13. Introduction text, should not be included in the list of references. Provide a context or background for the study (i.e. the They should be alphabetically arranged and must not nature of the problem and its significance). State the specific purpose or research objective of, or be numbered. hypothesis tested by, the study or observation. a. Article from a journal

iv Singh, R. S. & Oberhummer, I. (1980) Behaviour Kohavi, R. (1995). Psychosocial function in diabetics, therapy within a setting of karma yoga. Journal of Ph.D. thesis. All India Institute of Medical Sciences, Behaviour Therapy and Experimental Psychiatry, 11, Psychiatry Department, New Delhi. 135-141. l. Link / URL b. Article from a journal supplement Morse, S.S. (1995). Factors in the emergence of Orengo, C.A., Bray, J. E., Hubbard, T., LoConte L., & infectious diseases. Emerg Infect Dis [serial on the Internet]Jan-Mar [cited 1996 Jun 5];1(1). Available Sillitoe, I (1999). Analysis and assessment of cognitive from: URL: http://www.cdc.gov/ncidod/EID/eid.htm. impairment in head injured. Neurology, Neurosurgery & Psychiatry Suppl. 3, 149-170. The author should ensure that all the references cited c. In press article in the text are persent in list of references and that Kharitonov, S. A., Barnes, P. J., Behavioural and social there is no extra references in this list. adjustment. European Respiratory Journal, in press. d. Article from conference proceedings 17. Tables Jones, X. (1996). Prevalence of Mental & Behavioural Prepare tables on a separate sheet. Type or print each disorder. In Proceedings of the First table with double spacing. Number the tables NationalConference of World Psychiatry Association consecutively in order of their citation in the text and 27-30 June; Baltimore. Edited by Smith Y. supply a brief title for each. Wherever possible, avoid Stoneham:Butterworth-Heinemann; pp.16-27. making multiple boxes within the table. Do not use e. Book chapter, or article in a book vertical lines. Use minimum horizontal lines only. Set Kerkhof, A. J. F. M., & Nathawat, S.S. (1989). Suicidal table by tab key. Aviod using space bar. A sample behavior and attitudes towards suicide among students Table is shown below :. in India and the Netherlands: A cross cultural Table 1. Reaction time (in seconds) of schizophrenics comparison. In R.F.W. Diekstra, R. Maris, S. Platt, A. and normal subjects for different types of sensory Schmidtke & G. Sonneck (Eds.) Suicide and its stimulation. prevention: The role of attitude and intuition, pp. 144- 159, London: E. J.Brill. Conditions Schizo. (n=30 Normal (n=30) t f. Whole issue of journal Mean SD Mean SD Ponder, B., Johnston, S., Chodosh, L. (Eds.) (2006). Visual 1.7 0.94 0.7 0.01 0.45** Innovative oncology. In Breast Cancer Research, 10, 1-72. Auditory 3.0 0.02 2.6 0.96 0.11* g. Whole conference proceedings Smith, Y. (Ed) (1996). Proceedings of the First National p < . 01*, p < 001** Conference of World Psychiatry Association, 27-30 Authors should place explanatory matter in footnotes, June 2007; Baltimore. Stoneham: Butterworth- not in the heading. Explain in footnotes all nonstandard Heinemann. abbreviations. Each table should be cited in the text h. Complete book indicating it (e.g .‘Table.1 about here’). Margulis, L. (2005) Cognitive Sciences, New Haven: Yale University Press. 18. Illustrations i. Monograph or book in a series Figures should be submitted as photographic quality Hunninghake, G.W., Gadek, J. E.(1995).The alveolar digital prints in electronic files of figures in a format macrophage. In Cultured Human Cells and Tissues. (e.g., JPEG or GIF) that will produce high quality Edited by Harris TJR. New York: Academic Press. images in the web version of the journal (when ever 54-56. [Stoner G (Series Editor): Methods and the same will be prepared). Figures should be made as Perspectives in Cell Biology, Vol 1.] self-explanatory as possible. Titles and detailed j. Book with institutional author explanations belong in the legends, however, not on Advisory Committee on Genetic Modification. the illustrations themselves. If photographs of people (1999). Annual Report. London. are used, either the subjects must not be identifiable k. Ph. D. thesis or their pictures must be accompanied by written permission to use the photograph. Figures should be

v numbered consecutively according to the order in 4. The name and contact details of the corresponding which they have been first cited in the text. Type or author should be mentioned including e-mail address. print out legends for illustrations using double spacing, However, only the institutional address will be starting on a separate page, with Arabic numerals provided in the publication. corresponding to the illustrations. When symbols, In general, at least fifty percent of the authors should arrows, numbers, or letters are used to identify parts be the members (any category) of IACP. The of the illustrations, identify and explain each one clearly corresponding author should ensure that submission in the legend. and acceptance/rejection of an article be communicated to the co-authors. The Editor reserves the right to edit 19. Manuscript Submission or modify the articles depending on the requirement, The manuscripts should be typed clearly in Microsoft for which no communication shall be done with the Word format, in Times New Roman, Font size 12.on authors. one side on a paper of good quality in double space and leaving adequate margins. The article should conform to APA style. Three sets of hard copies (one Articles that do not meet any of the above printed on one side only and the other two back to requirements will be informed to the authors for back) should be submitted alongwith the CD. The revision before being considered for review by the electronic and hard copied should be idential. Each Editorial Board. Articles are assessed by Editorial article will be considered for review only after receiving, Board or by peer review. Articles not accepted for the soft and hard copies of the same. It should be publication will not be returned to the authors. After accompanied by a covering letter, which contains the review, the articles will be sent back to the concerned following information: authors for final revision and submission. 1. A statement that all authors have read the manuscript and have contributed to the work. All manuscripts are to be submitted to: 2. A statement that the material submitted has not been published elsewhere, nor is it under consideration S. P. K. Jena, Editor, IJCP, Department of for publication elsewhere. Applied Psychology, University of Delhi, South 3. The telephone numbers, fax and email addresses of Campus Juarez Road, New Delhi-110 021, India, the author(s). [email protected]

vi INDIAN JOURNAL OF CLINICAL PSYCHOLOGY

Indian Journal of Clinical Psychology (IJCP) is a half yearly publication of the Indian Association of Clinical Psychology (IACP). The Journal publishes original articles in all areas of clinical psychology and other allied social and behavioral sciences. It includes Research articles, Reviews articles, Case reports, Book reviews, News about Conferences, Letters to the Editor and Brief Communication etc. The purpose is to encourage scientific work in the area of mental health. It also incorporates research work on clinical and social issues concerning child, adolescent and adult mental health.

The Journal was started in 1974 and is being regularly published in March and September each year. The Journal has a large circulation amongst various professionals like clinical psychologist, psychiatrists, psychiatric social workers and those associated with mental health and social welfare agencies.The journal is abstracted in Psychological abstracts (USA) and Indian Psychological Abstracts (registered with the Registrar of Newspapers for India (RN 26039/74).

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Terms & Conditions /Mode of payment: Payment should be made by Cheque or Demand Draft drawn in favour of the Editor, IJCP, payable at New Delhi and sent to: S. P. K. Jena, Editor, IJCP, Department of Applied Psychology University of Delhi, South Campus, Benito Juarez Road, New Delhi, PIN-110 021 e-mail: [email protected].

Form IV

INDIAN JOURNAL OF CLINICAL PSYCHOLOGY, 2009, Vol. 37, No. 1 Statement about the ownership and other particulars about Indian Journal of Clinical Psychology: 1. Place of Publication : New Delhi 2. Periodicity of Publication : Half-Yearly 3. Printer’s Name : Sita Fine Arts Pvt. Ltd. , A-22 Naraina Industrial Area, Phase-II, New Delhi-110 028 4. Editor’s and Publisher’s Name : Dr. S. P. K. Jena 5. Nationality : Indian 6. Address : Department of Applied Psychology University of Delhi, South Campus, Benito Juarez Road, New Delhi PIN-110 021 e-mail: [email protected] Ph. 91-011-24111993 (R), 9818290430 (M) 7. Name and address of individuals & who own the newspaper & partners of share holders holding more than one percent of the total capital: Indian Association of Clinical Psychologists

I, Dr. S. P. K. Jena, hereby declare that the particulars given above are true to the best of my knowledge and belief.

vii Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 1-6. Jena / Editorial Clinical Psychologists (ISSN 0303-2582)

Editorial Evolution, Microgenesis and Neuropsychological Rehabilitation

Millions of years of evolution has kept and behaviour. But interestingly, this has not transforming the biologically simple species into only enhanced the possibilities of our survival hugely complex ones— right from microrganisms but also posed new threats to our existence. We to dinosaurian animals. Those who kept have emerged not only as crusaders for our own acquiring new skills of adaptation, survived the protection but also as potential destructors of atrocities of the nature and those who could not, our own species. Consequently, intelligent became extinct from the earth for ever. In this selection of affirmative action, and accurate process of evolution, the homo sapiens are prediction of the future has remained the two thought to have reached the pinacles of key determinants for our future survival. evolution. This long and eventful journey of During psychoevolution, learning has humankind has been a continuous process. played a crucial role. As a consequence of this, The recorded history of evolution has two important needs have emerged: (a) selection better accounts of the physical evolution, than of alternative ways of responding, and (b) the evolution that took place in human mind— in accommodating large number of learned our higher mental processes. We see the behaviours within the response repertoire, so that footprints of this evolving mind in primitive they will be available for future action. This earthen toys to cave paintings, and from stone formidable task has resulted in expansion of the weapons to gigantic spaceships ofrbiting the executive brain. Thus, behavior itself has shaped outer space. There are great advances in human the biological system as a whole. In this process, thinking. It compells us to believe that perhaps the routine and most frequently demanded we have not evolved in a manner in which other behaviours have become automatic— almost like species did. As far as our physical skills are reflexes, that hardly require involvement of higher concerned, we are pitiable, but we are evolved in centres of the brain. Some of them are executed the best possible manner in putting our thoughts with machine-like precision, like our signatures. into action. To numerours characters in Events of the past have become signals or mythologies and folk tales of people and animals symbols for future action. The art of survival is Gods and demons we have assigned supernatural learned not only through personal exposure to powers, which is impossible to be acquired by the critical events in the real world but also by an ordinary human being and created machines watching, imitating and internalizing them. Thus and instruments to overcome the genetically learning has been a significant part of the our acquired physical limitations (disabilities?). evolutionary history. Deficiencies in learning Today, we can move speedier than sound, leading to poor adaptation to the changing capture much finer frequencies of light and sound environment has forced the organisms to regress generated from millions of miles away in the to the lower state of evolution, resulting in outerspace. The inventive human mind has disorders of the body and mind and in extreme substituted ‘organ inferiorities’ with intellect and cases, death and extinction. state-of-art inventions, which in turn has been Remains of the fossilized human skull reveal intrumental in a speedier evolution of human mind that among the areas of the brain that has

1 Jena/ Editorial maximally changed their size over time, are the if there are serious and extensive damage to the frontal lobes. Hence this has been the focus of cerebellum, the disturbance is prominent when seminal body of literature, but the changes that the damage is bilateral (Holmes, 1907). These has taken place in other areas of the brain remain evidences indicate increasing role of the relatively unexplored. Take the case of neocerebellum in orchestration of higher mental cerebellum—the largest subcortical structure. For functions. a long time, it has been held that cerebellum is Beavioural demands placed by the involved in pure motor functions. Holmes (1922a) increasingly complex environment might have wrote, “main function of the cerebellum is the expanded the need for closer association between control of muscular contraction” (p.1177). lower and higher centres of brain which are Recently, this traditional view has been responsible for storage of these learning questioned. Dow (1974) explained that in experiences. This might have helped in monkeys, for example, with lesions restricted to arborization of new neurons developing closer the neocerebellum did not show any sign of association with the frontal lobes and cerebellar ataxia. Similarly “pure dentate lesion” consequent expansion of association areas.. — a sterotaxic surgery is conducted for treatment This evolutionary theory could be well of movement disorders. In light of these evidence, applied for understanding rehabilitation of we tend to believe that apart from other classical patients suffering from brain damage. However, functions, cerebellum is also engaged in storing before looking into the arena of rehabilitation, the motor patterns once they are learned. The we need to peep into some of the recent theoretical frontal association cortex and neocerebellum positions. together participate in “anticipatory use of cues” Apart from the evolution which is and “skillful manipulation of ideas” (Leiner, manifested in perceptible changes in behavior, Lenier, & Dow, 1986, 1989). Some authors even there are instantaneous evolution within us, that speculate that advanced evolution of occurs not in million of years but in the matter of neocerebellar systems in human beings may have milliseconds (Brown, 1988), called ‘microgenesis’, even provided neural circuitry for mathematical a generic term derived from the German word functions including those used in planning Aktualgenese, meaning, actual development and (MacLean, 1990). The notches found in refers to all developmental progression, which Paleolithic tally sticks indicate that capacity for occurs in short span of time and observable in its tabulating numbers appeared before the ability entirety (Draguns, 1991). Further, this term is to make verbal representations. Therefore, it is used in various contexts. We may perhaps prefix assumed that evolution of cerebellum itself might it with terms like ‘cognitive’, ‘behavioural’ have occurred earlier and influenced the ‘biological’ and so on. In this context, ‘cognitive’ development of the two principal functions : (a) microgenesis refers to the developmental anticipation and (b) planning of association changes that occur as a result of series of areas of the frontal lobes . These higher mental unidirectional forward flow from “archaic” to processes are consequences of ‘experiences’ “recent” structures, a kind of microtemporal that occurred at lower centres of the brain and unfolding of object (or idea) representation elsewhere in the body. (Brown, 1988). We, may also use a term like Speech is one of the latest capacities to behavioral microgenesis referring to the develop in the evolutionary history. It is response-guided micro level changes that occur integrated by the newer parts of cerebellum each moment in the organization of responses, (neocerebellum). Clinical evidence indicates that as the organism interacts with the immediate although speech is not seriously impaired even environment even without awareness. These

2 Jena/ Editorial micro processes have played a significant role in comes across a stimulus. This process helps in cerebral evolution. automatization and stabilization. Both the Every organism has a tendency to avoid a processes are viewed as biological necessities poorly poorly equilibirated state. This has been and are interrelated. The successive considered as the prime driving force within. In automatization of percept-genesis is the key to this sense, human microgenesis is primarily driven an effective energy economy. Automatization by conflict. This conflict may be caused by facilitates the redistribution of attention and imperfect activation of the memory content or an intentional effort (Smith, 1984). action schema corresponding to a Microgenesis occurs in the natural course contemporaneous stimulus feature or internal of human experience. Therefore, application of transformational activity; or mismatch between microgenetic approach to rehabilitation is an act an assimilated percept and a newly emerging, of facilitating and reviving the natural process of unassimilated or partially assimilated percept. development of cognitive activity, which is This drive for assimilation is an adaptive process disturbed due to brain damage. In this context that has evolutionary significance. Seeking the performance of a client which looks to be identification and recognition is one of the apparently meaningless is viewed as meaningful, fundamental genetic mechanisms, with a in the sense that many of these responses occur motivational property. This drive is found to be without the subject’s awareness and governed most prominent under conditions of stimulus by a regressed stage of regulation. A brain impoverishment, stimulus novelty as well as damaged adult’s writings and drawings may stimulus ambiguity (Dragnus, 1983). Hence, under appear like a child’s scribbling. It is like learning controlled conditions certain microgenetic to hold a pencil at an early stage of development process can be initiated for restoration of or even like the caveman’s primitive drawings. neurocognitive activities which are affected due Many of them are not even consciously aware of to brain damage. these mistakes they make. This kind of “pattern The application of microgenetic theory to deviance” (e.g. deviance of normally expected neuropsychological rehabilitation is a recent pattern of response) may also be seen in speech innovation and considered as a departure from disorders where the individual fails to have the conventional ones, such as stimulus- conscious control over it. There could be a facilitation, dynamic organization of functional discrepancy between the intended act and the system (Luria, 1963), psycholinguistic, or actual act. behavioural. Goldberg (1985) identified such An inherent feature of human perceptual possibilities while looking into the functioning and cognitive activity is a biogenic tendency to of supplementary motor area, which seems to be conserve, as a result of which we are able to extend involved in higher level planning. Lesion in this our capabilities and adaptations to newer and area may produce a syndrome of loss of more complex situations. It is the consequence intentionality. In this case the upper extremities, of an interactive process. Microgenesis involves if unattended to, will wander out of control and an act of going beyond the information given. seem to behave strangely, for instance touching Therefore, in this approach considerable focus some one, moving hands in air as if going to is placed on transformation of perceptual catch someone. Speech gets regressed like that experiences to conceptual ones i.e P-phase of of monosyllabic verbalization.There are likelihood experience to a C-phase experience. Repetition that such cases are likely to be misdiagnosed as of percepts helps in abbreviation of the percept- one with active visual hallucination and suffering genesis that takes place as soon as the individual from psychotic disorders, like schizophrenia.

3 Jena/ Editorial

Brain can be viewed as a functional unit areas of the brain usually require continuous rather than just a structural one. Microgenesis feedback as to what is being observed. involves an act of going beyond the information For neuropsychological rehabilitation that provided. This has rehabilitational and aims at ameliorating human performance, it is therapeutic implications. Hence, we assume that necessary to conceptualize what is meant by facilitation such self-propelled processes would ‘performance’. Technically, performance is be therapeutic for people suffering from cognitive viewed as an emergent phenomenon appearing disabilities due to brain damage. In a typical through an interaction between intentionality microgenetic paradigm, usually a degraded and environmental affordance, carried out in stimulus is presented to the subject and is being social context (Gibson, 1979). asked to describe the same. It focuses on Jackson (1958) described neural damage as personality of the individual, instead of taking a a situation where derangement of functions at purely cognitive view of the disability. higher levels give rise to regulation of behaviour With particular reference to brain tumor by lower levels. Currently this view has cases Carlsson et al. (1991) suggested that they undergone further change. Symptoms associated are more inclined than normal subjects to use with brain damage are now viewed as revelation primitive defensive strategies. One of them is of normal neural process but inadequately projection. Psychoanalysts localize the constrained. As a result of which it fails to reduce development of this defense mechanism at an the likelihood of errors. This is the reason for early stage of ontogenesis. A more advanced which performance becomes erroneous. The defense mechanism is isolation, which is often normal process of neural activity prematurely seen in right hemisphere groups of patients in surfaces without constraints. This view is not lateralization studies. Although a differentiation entirely incompatible with the Freudian concept between the hemispheres is not enough to explain of regression, in which abnormal behaviour is the difference between conscious and seen as poorly constrained expression of primitive preconscious processing, the right hemisphere impulses. is assumed to have better access to deeper layers In a similar vein, Brown (1988) explained of central nervous system than the left (Brown, that a lesion in the brain may act “like an 1988). Therefore, it is assumed that in this case, obstruction or partial blocking of a river” . This more primitive aspect of the brain is involved. blockage may lead to turbulence as well as The readers may be advised to refer to McLean divergence of flow. The view is not far from the (1967) for a detailed discussion on the subject.. psychodynamics of defense mechanism, About function of the brain, MacLean particularly when the integration of ego is under (1991) used that analogy of the feat of a base-ball threat. MacLean (1991) suggests that the player catching a high fly ball. Brain is seen as “a turbulence is close to the concept “chaos” and kind of built-in-calculus”. The role played by divergence close to “fractal geometry” or nerve impulse conduction and exoplsmic flow is “fractogenesis”. determined by the stimulus under process (or to However, the fact is that, due to brain be processed), hence highly goal-directed. damage, the performance becomes inherently Specifying the role of association cortex, erroneous. The possibility of occurrence of errors MacLean further states that, the association areas is in fact inherent to all life processes (Foucault, seem to provide their own “screen” for reflecting 1989). Through evolutionary process, every the associational forms of cerebration, whereas biological system has a built-in capacity to control for adaptation to the external reality other cortical errors. However, the degree, to which the errors are systematic, helps in use of the “error-control”

4 Jena/ Editorial mechanism. It statistically increases the chances neuropsychological perspective, Springer- of survival. The structure of “error action” helps Verlag: New York. the therapist to develop insight to the reason for Dow, R.S. (1974) Some novel concepts of constraint generating mechanism in damaged cerebellar physiology. The Mount Sinai brain (Shallice, 1982). Microgenetic process helps Journal of Medicine, 41, 103-119. in developing constraints and specifying the Foucault, M, (1989) Introduction: . In The normal behavior, as a result of which likelihood of errors and pathological. Zone Books: New York. in behavior decline. I believe that in order to Gazzniga, M. S. (1985) The social brain: provide best services to the patient a cross- Discovering the networks of the mind. Basic fertilization of theoretical ideas and practical Books: New York. decisions is desirable. Neuropsychologists Gibson, J. J. (1979) The ecological approach to should not only work by considering the the visual perception. Houghton Mifflin: classical views on the workings of brain, but also Boston. carefully examine the subjective experience of the Goldberg, G (1985) Supplementary and motor client. In this context, one level cannot be used area: A review of hypotheses. Behavioural to explain another, but an understanding of a and Brain Sciences, 8, 567-588. disorder from multiple angles would facilitate Holmes, G. (1907) A form of familial degeneration better care. Now teachistrscopic methods are of the cerebellum, Brain, 30, 466-489. used for exposing visual stimuli to the clients for Holmes, G. (1922a) The Croonian Lectures on the assissing the microgenetic process involved in clinical symptoms of cerebellar disease and elaboration and conceptualization of visual their interpretation. Lecture 1, Lancet, 1177- stimuli similar to the projectictive techniques. 182. Similar procedures can be adopted for auditory Jackson, J.H. (1958) On some implications of modality for exploring the dark horizons of the dissociation of the nervous system. In human brain. selected writings of John Hughling Jackson Much knowledge about workings of the Vo. 2 (J. Taylor, ed.) Basic Books: New York, brain is produced via psychological experiments pp. 29-44. (Original work published in 1882) (Gazzniga, 1985), hence, there is need for devising Leiner, H.C., Lenier, A.L. & Dow, R.S. (1986) Does new experimental paradigms such as the cerebellum contribute to mental skills. microgenesis to explore the inner world of the Behavioural Neuroscience, 100, 443-454. clients suffering from brain danage. Leiner,H.C., Lenier, A.I. & Dow, R.S. (1989) Reappraising the cerebellum: What does the References mid brain contribute to the forebrain? Behavioural Neuroscience, 103, 998-1008. Brown, J. W. (1988) The life of the mind. Lawrence MacLean (1967) The brain in relation to empathy Erlbaum: London. and medical education, Journal of Nervous Carlsson, I., Lilja, A., Smith, G. J. W., & Johanson, and Mental Disease, 144, 374-382. A. M. (1991)Application of Percept-genetic MacLean, P. D. (1990) Neofrontocerebellar methodology to neuropsychology, In R. E. evolution in regard to computation and Hanlon (Ed.) Cognitive microgenesis: A prediction: Some fractal aspects of neuropsychological perspective, (pp. 213- microgenesis, In R. E. Hanlon (Ed.) 239). Springer-Verlag: New York. Cognitive microgenesis: A neuro- Draguns, J. G. (1991) Microgenetic techniques of psychological perspective, Springer- personality assessment, (pp. 286-315) In R. Verlag: New York. E. Hanlon (Ed.) Cognitive microgenesis: A

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Shallice, T. (1982) Specific impairment of planning. Psychological processes in cognition and Philosophical Transactions of the Royal personality (pp. 135-142) Hemisphere: New Society of London, B239, 199-209. York. Smith, G. J. W. (1984) Stabilization and automatization of perceptual activity over time. In W. D. Frohlich, G. J. W., Smith, J. G. Draguns, & U. Henstchel (Eds.)

6 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 7-18 Aviation Psychology Clinical Psychologists (ISSN 0303-2582)

H.N. Murthy Oration Award 2009 Deriving Real World Solutions : The Art and Science of Aviation Psychology

1Catherine Joseph

Aviation psychology is the application of psychology to the hazardous and stressful occupations encompassed by aviation. It deals with problems faced by the personnel working in aviation environment; tries to find out causes for such problems and suggest remedial measures where ever possible. Psychological health has to be affirmed in relation to specific occupational requirements. There are two requirements; the occupational and the clinical. The occupational requirements involve three aspects: aeronautical adaptability, the high stress occupation of flying and psychological selection. Adaptability for military aviation is a complex issue, which involves motivation to fly, ability to fly, and psychological/ emotional suitability. The clinical requirements center around the aeromedical evaluation of pilots which are carried out at regular intervals to assess medical fitness for flying. Aviation mental health requires more than just clinical psychological normality to become a safe and effective aircrew because successful mission completion together with flight safety is of paramount concern. Issues related to testing and therapy in the aviation environment are discussed. Keywords: Aeronautical adaptability, Aircrew, Occupational mental health

Aviation psychology is the application of under prolonged stressors has to be carried out psychology to the hazardous and stressful regularly. Aviation mental health requires more occupations encompassed by aviation. Services than just clinical psychological normality to are typically offered on a unit or organisational become a safe and effective aircrew because level but interventions can be tailored for successful mission completion together with flight individual operators and their families (King, 1999). safety is of paramount concern. Psychological health has to be affirmed in relation The aviation psychologist has different job to specific occupational requirements. This paper roles depending on the occupational or clinical discusses the role of clinical psychology in requirements; these always involve team addressing the occupational related problems of decisions with other professionals such as military aircrew. The group of military aircrew aircrew, aviation medicine specialists, encompasses pilots, navigators and flight physiologists, optometrists and psychiatrists. The engineers. occupational requirements center around issues related to aeronautical adaptability, stress coping In aircrew, assessment of adequate in a high stress occupation and psychological motivation, stability, ability, maturity, selection. These have a direct bearing on aircrew attentiveness, perception, anticipation and flying performance in relation to specific tasks judgement to make good decisions related to such as judgment, decision-making, situational flying, and the hardiness and resilience to endure awareness in the air and crew co-ordination skills.

1Department of Aviation Psychology, Institute of Aerospace Medicine (IAM), Indian Air Force (IAF), Vimanapura, Bangalore 560 017, Correspondence: email: [email protected]

7 Aviation Psychology

The clinical requirements center around the reports of both initial and periodic examinations aeromedical evaluation of pilots which are carried of flying personnel, must assess the possibility out at regular intervals to assess medical fitness of aeromedically significant degradation of the for flying. Therefore the medical status of aircrew above attributes during the interval until the next is directly related to their flying status. Pilots who evaluation and even for a full military career are medically unfit are either permanently covering up to twenty years or more. grounded or are put back to flying in a phased manner depending on the nature, duration and One approach to gauging the mental health pattern of recovery of their disease/disability. of both prospective and trained aviators has been to have aviation medicine specialists formally Occupational Issues evaluate this matter as a part of required periodic Aeronautical Adaptability physical examinations. In addition to checking of the psychiatric status as “normal” on the Adaptability for military aviation is an examination form, psychological assessments of important aspect of the aeromedical evaluation. Aeronautical Adaptability (AA) are performed in Adaptability for military aviation is a complex the United States Navy (USN)and in the United issue, which involves motivation to fly, ability to States Air Force (USAF) where it is termed as fly, and psychological/emotional suitability (Jones Adaptability Rating for Military Aviation. Recent & Marsh, 2001). studies pertinent to AA have demonstrated the Motivation involves the desire to fly. A relevance of the five factor personality trait scores healthy motivation to fly contains some elements to human factors associated with aviation of rational choice (it’s a good job), and some of mishaps, aviation combat effectiveness and emotional attraction (I’ve wanted to fly since cockpit resource management. childhood). How a pilot flies an aircraft can be The Five Factor Theory of “normal” influenced by motivations, which may not involve personality traits proposed by Costa & McCrae, specific diagnosis. Some people may wish to fly is a frequent component of the psychological for reasons arising from disordered self concept, evaluation of aviators (Costa & McCrae, 1992). A or neurotic drives arising from early childhood combination of NEO-PI-R scores associated with experiences involving power, control, authority, inadequate compartmentalisation, impulsivity, low or attempts to fulfill the desires of others, and self-discipline, and excessive modesty has been similar issues. used to identify individuals who are Not Ability involves various physical, Aeronautically Adaptable (NAA). cognitive, autonomic, neurophysiological, and Significant differences between the AA and psychological attributes. These include spatial NAA groups on three of five factor scales perception, mental calculations, suppression of (Extraversion, Neuroticism and emotional reaction to emergent situations in favor Conscientiousness) were found (Ellis, Moore & of analysis and correct action, psychomotor skills Dolgin, 2001). NAA individuals could be and alertness to a wide variety of sensory inputs described as inefficient, undependable, self- along with an accurate filter that screens out effacing, pessimistic, easily overwhelmed, sober stimuli of no aeronautical importance. Matters and sedentary compared to AA individuals. In a relating to personality, attitudes and interpersonal sample of NAA individuals sixty seven percent relationships comprise stability. A balance of these were found to have “Cluster C” traits as defined capabilities is necessary to fly safely and well. by DSM-IV. The largest groups were associated Aeromedical authorities who evaluate with obsessive compulsive, dependent, avoidant

8 Aviation Psychology and narcissistic traits (Moore, Ellis, & Dolgin, determination of female psychological fitness to 2001). More formal research efforts in this area fly is complicated. One particular challenge is that need to be conducted. male aviators may cast female counterparts into inappropriate roles (Jones, 1983). On interview, Pilot personality the majority of male voiced concern about their proclivity to protect women in combat. Female The study of pilot personality has evolved participants were concerned about potentially from interest in selection and training issues to being used to exploit captive male comrades-in- the present day concerns relating to flying arms (McGlohn, King, Butler & Retlaff, 1997) performance and safety. Pilots as a group or as The identification of homogenous different subgroups are said to have some similar personality traits among successful pilots might, personality characteristics. A classic study of pilot at first glance, provide a convenient and useful personality and adaptation in a sample of way for evaluation of psychological suitability of experienced USAF pilots (Fine & Hartman, 1968) an individual for military aeronautics. However, found that “typical” pilots tended to be dominant, there are difficulties with this approach. First, outgoing, active and achievement oriented with psychometric studies of pilot personality have strong needs for novelty and change and mastery relied on “mean” comparisons among the groups of their environment. They were also described using the scale averages for the samples. This as lacking in introspection and as controlled in approach empirically emphasises homogeneity the expression of emotion. Similar personality and obscures variability, or heterogeneity within characteristics were also reported in a sample of the sample, leading to the “myth of pilot USN pilots who were rated as “outstanding” and personality” (King, 1999). Secondly, such studies as the “top 10%” in their flying squadrons by imply that the nature and degree of the Reinhardt, (1970) and a sample of experienced characteristics identified constitute the “right Royal Australian Air Force pilots (Ashman & stuff” for military aviation and anything less is Telfer, 1983). not adaptive. The right stuff is not the “only stuff” Later evidence showed that there are at least when it comes to personality types likely to be several different “types” of individuals who successful in military aviation (King, McGlohn & successfully adapt to military aviation. Three Retzlaff, 1997). Thirdly, there are many different distinct personality subtypes were empirically motivations to fly. What is not known is whether identified. (Retzlaff & Gibertini,1987; Picano, particular characteristics are required for the job 1991). or if the job attracts people with these traits, or if Comparable findings have been reported in both factors are operative. Therefore attempting civilian general aviation pilots for both males and to understand the individual aviator is very females (Novello & Youseff, 1974). The important. Such findings warn against relying on determination of personality comparisons of pilot personality stereotypes and preconceived female versus male pilots suggests greater female notions for determining suitability for military extraversion, agreeableness and aviation. These, especially if they are conscientiousness (King, McGlohn & Retzlaff, personalised, need to be avoided. 1997). These traits may be highly adaptive for military pilots, given the nature of modern The results of conventional tests operational requirements. All aviators have a administered to pilots as a group, were initially unique psychological profile and female pilot utilised to some extent for selection, training and candidates are not a representative sample of the mental health considerations. As research general population (Lyons, 1991). Hence developments took place, the emphasis was

9 Aviation Psychology shifted to personality assessments of qualities One of the first studies to speculate that faulty thought to be of relevance to flying performance. pilot judgement might be related to the pilot’s Personality is of relevance to human factors susceptibility in situational factors affecting their associated with aviation mishaps, aviation combat psychological status and mental operations was effectiveness and cockpit resource management. Jensen & Bernel’s in 1977. From a four years review of general aviation accident data, they concluded The criteria used to identify “superior” that faulty pilot judgement was implicated in 35% pilots have expanded to encompass operationally of the non-fatal and 52% of all fatal human-factors relevant measures as long term safety records accidents. (Sanders & Hoffman, 1975; Sanders, Hoffman & Neese 1976; Dolgin, Gibb, Nontasak & Helm, After this study was completed, the Federal 1987).Personality may thus be one of the many Aviation Administration contracted with Embry- factors, in the chain of events and situations, Riddle Aeronautical University (ERAU) to develop which may cascade to ultimately precipitate an educational materials for pilot judgement training. accident or incident. In a more recent study, pilots In addressing this issue, ERAU researchers, from different aircraft, agreed that the personality (Berlin et al., 1982), isolated five specific thought trait of conscientiousness, was the most important patterns or attitudes from the literature that might determinant of effective performance, such as serve as precursors to faulty judgement and flying skills and crew management (Siem & labeled them “hazardous thought patterns”. The Murray, 1994). five basic hazardous thought patterns affecting decision-making are anti-authority, impulsiveness, In India, the “personality profile of a highly invulnerability, macho and resignation. These rated IAF pilot” was described as “above average thought patterns also known as attitudes, in abstract thinking, high stress tolerance, resilient, influence information processing and may affect decisive, practical, sober and dependable”. No judgement and decision-making( Berlin et al., statistical differences between fighter and 1982).Subsequent empirical research (Telfer, 1987), transport pilots were found (Ramachandran et with hazardous thought patterns added a sixth al., 1983). However, in absolute scores, fighter pattern: deference, seen in pilots who bow to pilots were higher on intelligence, self sufficiency pressure to conform to their peers or to authority. and emotional stability. The hazardous thought patterns represent Two personality dimensions, instru the mediating process between an event and a mentality and expressivity have been found to be pilot’s decision-making outcome. These important in cockpit resource management constructs continue to be further validated. (Gregorich, Helmreich, Wilhelm, & Chidester, 1989). However, education about hazardous thought Pilots who had a strong orientation towards work, patterns which incorporates the individuals’ achievement and mastery combined with high appraisal of their own decision-making processes levels of positive expressivity and low levels of can form a part of an aviator’s continuing competitiveness and verbal aggression, were best aeromedical education and training. suited for work in multicrew cockpits. Stressors and Coping Hazardous attitudes Occupational demands of some aviation Pilot judgment involves a complex series of jobs such as flying and air traffic control can be psychological processes by which the pilot highly stressful in terms of responsibility, time analyses and evaluates information about the and performance and have been categorised as environment, the aircraft and himself resulting in “very high risk” ones. Few professions carry so decisions about the safe operation of the aircraft.

10 Aviation Psychology much of responsibility in terms of lives, and the highly desirable cognitive, personality and potential effects of stressful experiences are of emotional factors that predict more successful importance to all personnel working in the aviation applicants for flying training and flying careers. environment. A number of information processing Though research in this area is relatively less skills are involved in flight tasks such as attention, developed, the important issues can be classified perception, memory, decision making and action as ability, stability and motivation. All three of and these when affected by stressors result in these characteristics may be necessary for flying impaired performance. status but may not be sufficient. It may also be true, however, that simultaneously high levels of The results of a study on Indian commercial all three are not an absolute requirement for flying airline pilots indicated that there was a statistically training or a successful career (Patterson, 1991). significant incidence of both domestic and occupational stressors in their sample (Joseph, Psychological selection of aircrew is carried Maitra, Nayar & Reddy, 1995). Increase in out at the AF selection centers at Mysore, domestic stressors was associated with an Varanasi and Dehadun. The selection tests are increased level of coping and trait anxiety. Higher developed and standardized at the Defence occupational stress and high anxiety were linked Institute of Psychological Research (DIPR) at to lowered job satisfaction, level of coping and Delhi. Inputs are provided to these agencies from self perceived performance. Factors such as age, IAM because flying personnel are seen for seniority, marital status and government/ private evaluation during their career in IAF. In the late organisation were seen to be important factors 90’s two studies comparing a group of airman influencing stressors and outcomes. A more trainees who got discharged from service with a recent study on Indian military pilots found that normal group were carried out. Recommendations they utilized problem focused, acceptance and were that personality selection be included at social support stress coping strategies in line with entry level to reduce attrition for airmen (Joseph previous western studies (Ayengar & Joseph, & Roopa, 2001). A computerized psychomotor test 2009). was developed and validated and provided an input for further development at DIPR of a new Psychological Selection aircrew selection test battery (Bhatnagar, Joseph Psychological evaluation and testing is a & Raju, 1999) and in 2002 the first contrast major component of the selection process in some sensitivity study on aircrew in India was reported, civil and military aviation programs. Psychological the authors indicated it’s usefulness as a evaluation for selection can be divided into two screening tool for aircrew candidates and for both areas: select-out and select-in. Select-out tests operational and diagnostic purposes (Swamy, are used to screen out undesirable or pathological Joseph, Aravind & Vevai, 2002). characteristics of an individual that may be Clinical Requirements incompatible with flying. and do not meet flying standards for training, or retention and return to Psychological Evaluation and Therapy flying. Pathogonomic signs, psychiatric Aeromedical considerations in the area of diagnoses, or even subtle cognitive disturbances retention are characterized by two main questions. and personality factors are identified. These may The first question involves the routine annual result in an individual’s failure to learn to fly or flying medical examination. The second, is the failure to progress in a flying career (Patterson, reflighting question, involves returning an aviator 1991). to flying status after there has been a medical Select-in psychological tests identify problem such as head injury, anxiety or suicide

11 Aviation Psychology attempt. During the aero medical examination, if as aviators’ age, the strength of the components indicated, aircrew may be referred for of motivation to fly changes (Joseph & Ganesh, psychological evaluation or therapy. 2005). The psychological evaluation process, in Finally, the clinical interview should include general, involves two components: the clinical an assessment of mental status, one such method interview and the psychological testing is reflected in the acronym AMSIT: Appearance (Patterson, 1991). The clinical interview involves (behaviour and speech), Mood (and affect), history, current functioning, motivation and Sensorium, Intellectual function and Thought adaptability to fly and the mental status (Leon, 1989). It should be modified to include examination, which is an impressionistic issues sensitive to relevant aeromedical concerns. description of the aviator’s status. Personal Psychological testing is the second history of the aviator should include educational, component of psychological evaluation, social, health and marital information, and any categorised into two broad areas: history of legal conflict or entanglement. neuropsychological tests and personality/ Information about spouse, parents and siblings psychological adjustment tests. The areas of with particular emphasis on physical and mental neuropsychological test evaluation include health, occupation and work history should also memory, attention/concentration, information be obtained. Current functioning in the aviator’s processing and language. Both clinical norms current situation should include sleep, diet, developed from hospital databases and norms exercise, and other health habits as well as marital, developed specifically for aviators are used. interpersonal and leisure time information. The neuropsychological testing evaluates A review of the pilot’s motivation to fly can aeromedical referral questions such as closed head be very important as this may change across the injury (HI), unexplained loss of consciousness flying career. Motivation to fly can be viewed as (LOC) in the air/on ground, memory change, aging, how one first got interested in flying, what training and upgrade issues, and flying deficiency. continues to draw the individual to flying, how one deals with the dangers of flying, and any Psychological evaluation findings in head disappointments or fears about flying. Motivation injured aircrew during the period 1985-1995, at to fly also involves others’ perceptions such as the Institute of Aerospace Medicine, Bangalore those from both the individual’s occupational and (Maitra, Roopa & Chandramohan, 1997) found domestic fronts. This may include the instructors, that, 37% of aircrew showed some psychological commanding officer / flight commander and peers syndrome six months after HI and 5% of these in the squadron and the individual’s spouse or continued to show some psychological deficit parents. A good understanding of why the even after three years. However, this evaluation individual chooses to fly is an important part of was not fully adequate in helping in disposal of the assessment. Motivation to fly can be healthy HI cases and hence there is need to review and and strong or overdetermined, insufficient, or “for update the neuropsychological assessment and the wrong reasons”. A further categorisation of other investigative methods, so as to rationalize motivation refers to appropriate motivation for the disposal of these cases (Krishnamurthy, the type of flying: military, combat, private, or Nayar, Kapur & Joseph, 1997). commercial airline and the type of aircraft one Accurate assessment of an aviator’s prefers to fly in the given circumstances ie. fighter, functioning is difficult because of a number of helicopter or transport. Each of these types of reasons. Firstly, because of the typically high flying requires variations in motivation and often

12 Aviation Psychology levels of performance noted on intellectual Issues in clinical assessment and therapy functions (King & Flynn, 1999). Secondly the Psychological assessment, in this set up patient is assessed after an increased period of tends to have it’s own challenges. There are a time has elapsed and never immediately after the number of important clinical conditions that are HI and neuropsychological recovery would have found in aircrew which are similar to the general already set in within this time period. Pre injury population such as depression, anxiety, alcohol and initial post insult data are usually unavailable. use and misuse/abuse, somatisation/pain Thirdly, conventional neuropsychological evaluation (in medical conditions and in batteries such as the Luria Nebraska/Halstead musculoskeletal disabilities) and PTSD. Some Reitan can be used to assess changes in gross conditions however, are unique to the flying dysfunction. However, they may be inadequate occupation such as fear of flying (FOF), lack of to gauge the subtle abilities that performance in a aeronautical adaptability such as reduced/lack of high demand environment requires. motivation for flying, motion sickness in the air, The applicability and development of stress reactions to flying conditions, low G neuropsychological tests with improved tolerance/ G LOC, ejection injuries, post accident/ relevance to aerospace medicine such as the incident analyses, malingering and reverse Cogscreen, Microcog, and Automated malingering. In all these conditions, psychological Neuropsychological Assessment Matrix factors can play a role in the genesis, maintenance (ANAM) has helped computer aided assessment or recovery of the illness/disability. of cognitive factors in mental and neurological In psychological evaluation of aircrew and conditions. Many of these test measurements are other military personnel in our laboratory, scores pertinent to flying (Jones & Marsh, 2003). of the internal validity scales of personality Personality/psychological adjustment tests questionnaire tests were found to be elevated in comprise the second category of tests used for over 55% of subjects, making results less reliable psychological evaluation of aviators. These tests and therefore projective techniques are a must in measure both the long standing personality most evaluations (Joseph & Roopa , 2001; Thomas structure of an individual, as well as the aviator’s & Joseph, 2005; Joseph, Thomas & Roopa, 2005a; current psychological adjustment. Anxiety, Roopa & Joseph, 2004). Projective tests used are depression, energy level, self concept, personality sentence completion forms, Thematic style and traits, and psychological defenses are Apperception Tests and the Rorschach Ink Blot measured. The aeromedical referral questions test. Therefore in this situation, more accurate appropriate for personality tests include fear of information can be gained when both subjective flying, reduced/lack of motivation for flying, and objective psychological tests and the clinical alcohol use and misuse/abuse, somatisation/pain interview are used to supplement each other. evaluation, stress reactions, and malingering. Standard forms of counseling and Personality tests can be grouped into psychotherapy such as behaviour therapy, projective and objective tests. Examples of some cognitive behavioural therapy and client centered objective tests used in aeromedical evaluation therapy are utilized when required. The nature of include those that measure general personality the problem and individual characteristics of the traits like the NEO-PI, and Sixteen Personality aircrew determines the outcome. Individuals who Factor Test and those that measure symptoms of experience sudden and highly stressful various clinical conditions eg. MMPI and Million occupational situations, and are open to alter their Multiaxial Inventory. present intolerable mental states, respond well to

13 Aviation Psychology short term, directive crisis oriented treatment. need to inform the unit and the commanding However, others who have experienced long term officer. In aviators, flight safety assumes a more psychological distress and maladjustment may important role than confidentiality because the have individual characteristics, which act as client’s life may be at risk. resistant forces to therapy, and treatment may be Aircrew also tend to seek help from outside prolonged and sometimes unsuccessful. civil sources, which remains unknown to the In medically unfit aircrew, psychological military health specialists. The military, the world factors such as anxiety or somatisation may over are presently studying this issue and looking sometimes influence their speed of recovery for ways to ensure that military personnel seeking (Joseph & Roopa, 2009). These factors, which counseling can do so with military providers would otherwise be considered as negligible in a without threat to their careers. As a part of their non-aircrew population, have to be dealt with in suicide prevention program, the USAF changed aircrew. This is usually achieved through brief their policies to promote help seeking behavior psychotherapy, by which motivated aircrew may and protect personnel who seek help for their make gains in personal growth. Whichever the problems (Litts, Moe, Roadman, Janke, & Miller, case, the psychological treatment here differs 1999). because; the therapist is to take into consideration Once psychological help is sought or both the interests of the individual and his/her imposed, lack of disclosure is often a major occupational role in the organization. difficulty and affects the counselor-client Recognizing the impact of both the micro- relationship of mutual trust. Aircrews’ lives and context (military organizations, commander’s professions are heavily influenced by others unique personalities and leadership style, varying decisions and they may feel particularly duties and missions, all complicated by the client’s vulnerable to the consequences of self-disclosure. perception of these elements) and macro-context Differing motivation results in either faking (structure and set of values and regulations of “good” or “bad” /malingering/reverse the larger military organization) in resolving malingering depending on the motivation to aircrew’s problems is fundamental to successful continue in flying, change their a/c stream, or get individual counseling/therapy. release from service on medical/psychological grounds (Joseph, Thomas & Roopa, 2005a). In Often, aircrew believe that seeking mental such cases rapport building becomes extremely health services will damage their military careers. important and time required for counseling/ One of the main issues is the link between health psychotherapy may need to be longer in some and occupational status, both psychological and cases. Disclosure is generally higher to civilian physical health is gauged by being either fit/unfit counselors and therapists who are able to build for duty. If unfit, the different categories of fitness up trust and rapport well. have been devised in relation to specific aspects of the job accepted and required to be performed. Being a selected population, certain It is critically important that the counselor be personality characteristics of military personnel aware of this and reassure the client that may differ from civilian populations. Our studies confidentiality will be maintained to the extent have indicated more of emotional inhibition in that appropriate ethical standards allow. However military personnel (Joseph & Roopa, 2001; Roopa this could create ethical dilemmas in the counsellor/ & Joseph, 2004), possibly because of the therapist between the client/organisational authoritarian leadership styles and hierarchical “good”. The counselor/therapist has to gauge organizational structure which lead to suppression the impact on the client’s flying duties and may of emotions. Counselors/therapists may thus in

14 Aviation Psychology some cases need to use more directive methods, advantage of the hierarchical organisational be more patient, empathic and reassuring and structure and benefits of using and training lay more importantly be very alert and discerning. counselors (Joseph et al, 2004). There may also be some personality differences Psychological evaluation and therapy due to culture which the psychologist needs to should result in relevant recommendations about be aware of. For instance our experience with flying status based on the examiner’s experience Indian military aircrew suggests that they tend to and the specific evaluation of the aviator. These give equal preference for both achievement and evaluations are time consuming and highly affiliative work needs, have lower internal locus dependent on the experience and training of the of control and higher external locus of control examiner. It requires the ability to distinguish compared to their western counterparts (Joseph, between both the gross normal/abnormal and the Thomas & Roopa, 2005b; Kochhar & Joseph, subtle aspects of different normal personality and 2006; Joseph & Ganesh, 2006).This could affect social functions, needed for this type of the counselor’s/therapist’s evaluations in the occupational adjustment. Thus, if well-informed psychotherapeutic setting. Certain principles of and trained psychologists, psychiatrists and counseling/psychotherapy may be incongruous psychologically aware aviation medicine with occupational role eg. in military fighter pilots, specialists work together, they can resolve highly psychological defence mechanisms are a healthy complex neuropsychiatric and aeromedical requirement and therefore should not be broken questions, which would result in clear and concise down in therapy, if the person has to return to diagnoses, recommendations and disposals. flying (Joseph & Kulkarni, 2003). Group counselling/therapy is particularily Psychological factors in fear and extreme stress useful in some cases such as in critical incident reactions during flying stress debriefing after accidents/incidents.Many of the strengths of counseling groups are An example of important clinical conditions particularly applicable to soldiers.Because is fear and extreme stress reactions during flying. participants are other aircrew their feedback to FOF is generally seen in student pilots but also one another can be particularly helpful. Group occurs in experienced aviators. Fear and extreme members can provide helpful insights about the stress reactions can also manifest as paralysis of difficulties and the necessary adjustments action, anticipatory stress reactions and “combat associated with these situations. It fosters a sense stress” (Joseph, 2007). Anticipatory stress may of belonging and cohesion (Corey, 2000), essential occur in aircrew preparing for combat encounters to unit morale and esprit de corps (Cota, Dion, including war, important check rides, and other Evans, Kilik, & Longman, 1995). Aviation threatening events. It could manifest as faint psychologists also provide extensive unease/trembling, vomiting or even an outright psychoeducational presentations to all levels of refusal to fly. their organization. The presentations are Anxiety about flying can assume a wide structured to address the specific responsibilities range of overt physical (rapid heart beat, excessive of officers, and noncommissioned officers. Major perspiration, airsickness) and emotional topical areas are: (a) suicide awareness, (b) stress (nightmares, cognitive impairments such as spatial management (c) anger management, and (d) other disorientation, guilt, lack of control) symptoms. It gender awareness. The work on suicide can encompass recognised psychiatric disorders. prevention in the IAF indicates the efficiency with These are generally of a neurotic type and include which programs can be carried out reflecting an dissociative disorders involving fragmentation of

15 Aviation Psychology memory systems (amnesia), psychosomatic which allows the expression and verbalisation of ailments and conversion reactions. potential conflicts may also be found effective. The clinical expression and mode of onset For generalization to actual flight, three of FOF may be sudden, or gradual. It may surface goals are taken into consideration; incremental during some flying missions like formation flying, flight conditions according to the individual’s high or low altitude flying, with low visibility. The anxiety hierarchy, regulation of the low workload, flyer may either express the fear or sometimes may anxiety vulnerable time during each sortie and try to cope with it by hiding and minimizing his the practice of relaxation techniques in the air. It problems. It can also be expressed as maladaptive has been found that actual exposure to flying is professional behavior and personal relations. The usually necessary for aircrew to recover from triggering and promoting factors may be anxiety associated with flight. discovered by examination, associated with Conclusion professional, personal, or emotional life. The current consensus on the above subject is that In conclusion clinical psychology can generalised FOF is associated with highly anxious address some of the occupational related personality types while more focussed reactions problems of military aircrew. More than just are likely to have specific environmental discerning between normal and abnormal precipitants. behaviour is required to assess aircrew psychological health because the requirement is FOF occurs when there is a breakdown in to get aircrew back into the cockpit with no personality organization of healthy defense compromise on flying performance/flight safety. mechanisms, which are generally used during This involves looking into aeronautical flying. This results in internal conflicts, which adaptability, stress coping in a high risk generate uncontrollable manifest or latent fear. occupation and effective psychological selection. Joseph & Kulkarni (2003) suggested a different Issues related to psychological testing and classification of FOF cases, namely (i) psychiatric therapy include establishing good rapport to disorder (ii) psychological dysfunction and (iii) ensure adequate disclosure, overcoming ethical inadequate professional behaviour. Based on this, dilemmas and establishing accurate norms based a more objective, scientific and well defined on cultural and group phenomena. approach for medical/ administrative disposal needs to be considered for IAF aircrew. Most effective therapy programs have References involved a variety of behaviour therapies, most often relaxation techniques such as autogenic Ashman, A. & Telfer, R. (1983). Personality profiles training and progressive relaxation and systematic of pilots. Aviation Space and Environmental desensitization and more recently virtual reality Medicine, 54, 940-943. graded exposure with biofeedback. However, Ayengar P.D. & Joseph, C. (2009). Aviation safety pilots who recover differ in certain characteristics locus of control, stress coping and personality in such as not being trait anxious and having more Indian military pilots. Paper presented at the 49th situation specific anxiety The reality element in Indian Society of Aerospace Medicine Conference, 30 Nov- 02 December; Delhi. the flying situation can also be achieved by using Berlin, J.I., Gruber, E.V., Holmes, C.W. et al. (1982). appropriate simulators and the levels of anxiety Pilot judgement training and evaluation.. DOT/ controlled by modifying the simulator programme, FAA/CT-82/56, Embry Riddle Aeronautical maintaining the presence of a therapist and if University, Daytona Beach, FL. required using an anxiolytic drug. Psychotherapy

16 Aviation Psychology

Bhatnagar, K., Joseph, C. & Raju, K.S. (1999). Aerospace Medicine, 49, 2, 57-67. Preliminary validation of a computerized Joseph, C., Maitra, A.K., Nayar, G.S. & Reddy, I.R. psychomotor test. Indian Journal of Aerospace (1996). Psychological stress and coping- a Medicine, 43, 2, 49-58. preliminary study on Indian commercial airline Costa, P.T. & McCrae, R.R. (1992). Revised NEO pilots. Indian Journal of Aerospace Medicine, 40, Personality Inventory (NEO-PI-R) and NEO Five 2, 33-40. Factor Inventory (NEO-FFI) Professional Joseph, C. & Roopa, C.G. (2009). Mind matters: Manual. Odessa, FL: Psychological Assessment psychological factors in aircrew illness.Paper Resources Inc. presented at the 49th Indian Society of Aerospace Cota, A. A., Dion, K. E., Evans, C. R., Kilik, L., & Medicine Conference, 30 Nov- 02 December; Longman, R. S. (1995). The structure of group Delhi. cohesion. Personality and Social Psychology Joseph, C. & Ganesh, A. (2006). Aviation safety locus Bulletin, 21, 572-580. of control in Indian aviators. Indian Journal of Dolgin, D.L., Gibb, G.D., Nontasak, T. & Helm, W.R. Aerospace Medicine, 50, 1, 14-21. (1987). Instructor Pilot Evaluations of Key Naval Joseph, C. & Kulkarni, J.S. (2003). Fear of flying: a Primary Flight Criteria. NAMRL-1331, Naval review. Indian Journal of Aerospace Medicine, Aerospace Medical Research Laboratory, 47, 2, 21-31. Pensacola, Florida. Joseph, C. & Roopa, C.G. (2001). Rorschach analysis Ellis, S., Moore, J. & Dolgin, D. (2001). Aviator of personality and adjustment in airmen trainees personality assessment: Part I- aeronautical referred for psychological assessment. Indian adaptability. Aviation Space and Environmental Journal of Aerospace Medicine, 45, 2, 47-57. Medicine, 27, 3, 254. Joseph, C. Roopa, C.G., Uday Kumar, G.S., Bhatti, Fine, P.M. & Hartman, B.O. (1968). Psychiatric R.S., Parthasarathy, R., Gupta, J.K. & strengths and weaknesses of typical Air Force Krishnamurthy, A. (2004). Prevention of Suicide: pilots. Report No SAM- TR-68-121. Brooks Air The IAM awareness training programme. Indian Force Base, TX: USAF School of Aerospace Journal of Aerospace Medicine, 48, 2, 8-16. Medicine. Joseph, C. Thomas, B. & Roopa, C.G. (2005a). Test Gregorich, S., Helmreich, R.L., Wilhelm, J.A., & taking response styles and associated personality Chidester, T. (1989). Personality based clusters traits in aircrew during medical evaluation. Indian as predictors of aviator attitudes and performance. Journal of Aerospace Medicine, 49, 2, 1-10. In: Proceedings of the Fifth International Joseph, C. Thomas, B. & Roopa, C.G. (2005b). Symposium on Aviation Psychology, Columbus; Motivational work needs and personality factors Ohio. in aircrew. Indian Journal of Aerospace Medicine, Jensen, R.S. & Benel, R.A. (1977). Judgement 49, 2, 48-56. evaluation and instruction in civil pilot training. King, R.E. (1999). Aerospace Clinical Psychology.; Final Report FAA-R-D-78-24, NTIS.; Hants: Ashgate Publishing Ltd. Springsfield, Virginia. King, R.E. & Flynn, C.F. (1995). Defining and measuring Jones, D.R. & Marsh, R.W. (2001). Psychiatric the “right stuff”: Neuropsychiatrically enhanced considerations in military aerospace medicine. flight screening (N-EFS). Aviation Space and Aviation Space and Environmental Medicine, 72, Environmental Medicine, 66, 10, 951-956. 129-135. King, R.E., McGlohn, S.E. & Retzlaff, P.D. (1997). Jones, D.R. (1983). Psychiatric assessment of female Female USAF pilot personality: The new right fliers at the USAF School of Aerospace Medicine. stuff. Military Medicine, 162, 695-697. Aviation Space and Environmental Medicine, 54, Kochhar, R. & Joseph, C. (2006). Motivation, 929-931. personality and locus of control in Indian military Joseph, C. (2007). An overview of psychological factors pilots. Paper presented at the 54th International and interventions in air combat operations. Indian Congress of Aviation & Space Medicine, Journal of Aerospace Medicine, 51, 2, 1-16. September 2006; Bangalore. Joseph, C. & Ganesh, A. (2005). Motivation for flying Krishnamurthy, A., Nayar, G.S., Kapur, B. & Joseph, in military aircrew: a review. Indian Journal of C. (1997). Head injury and fitness to fly - need

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for a review. Indian Journal of Aerospace Medicine, Ramachandran, N., Wadhawan, J.M., Kumar, V., 41, 1, 66-74. Chandramohan, V. & Rao, P.L.N. (1983). Leon, R.L. (1989). Psychiatric Interviewing: A Primer. Personality profile of an IAF pilot: Its usefulness 2nd Ed, New York: Elsevier Science Publishing. in pilot selection. Aviation Medicine, 21, 2, 131- Litts, D.A., Moe, K., Roadman, C.H., Janke, R., & 139. Miller, J. (1999). Suicide Prevention Among Active Reinhardt, R.F. (1970). The outstanding jet pilot. Duty Air Force Personnel - United States, 1990- American Journal of Psychiatry, 127, 732-736. 1999. Center for Disease Control and Prevention, Retzlaff, P.D. & Gibertini, M. (1987). Air Force pilot Mortality and Morbidity Weekly Report, 48, 46, personality: hard data on the right stuff. 1053-1057. Multivariate Behavioural Research, 22, 383-389. Lyons, T.J. (1991). Women in the military cockpit. Sanders, M.G., Hoffman, M.A. & Neese, T.A. (1976). AL-TR-1991-0068.;Washington DC: US Cross validation of personality aspects of Government Printing Office. involvement in pilot-error accidents. Aviation Maitra, A.K., Roopa, C.G. & Chandramohan, V. (1997) Space and Environmental Medicine, 47,177-179. Head injury: psychological aspects. Indian Journal Sanders, M.G. & Hoffman, M.A. (1975). Personality of Aerospace Medicine, 41, 2, 61-67. aspects of involvement in pilot-error accidents. McGlohn, S.E., King, R.E., Butler, J.W. & Retlaff, Aviation Space and Environmental Medicine, 46, P.D. (1997). Female USAF pilots: themes, 186-190. challenges, and possible solutions. Aviation Space Siem, F.M. & Murray, B.S. (1994). Personality factors and Environmental Medicine, 68, 132-136. affecting pilot combat performance: a preliminary Moore, J., Ellis, S. & Dolgin, D. (2001). Aviator investigation. Aviation Space and Environmental personality assessment: Part II-maladaptive Medicine, 65, A45-A48. personality traits. Aviation Space and Swamy, S., Joseph, C., Aravind, A.S. & Vevai, R.J. Environmental Medicine,72, 3, 254. (2002). Contrast sensitivity in IAF aircrew. Indian Novello, J.R. & Youseff, Z.I. (1974).Psychosocial Journal of Aerospace Medicine, 46, 2, 7-22. studies in general aviation: II. personality profiles Telfer, R. (1987). Deference: pilots who bow to the of female pilots. Aviation Space and Environmental pressure to conform to their peers or to authority. Medicine, 45, 630-633. Pilot judgement training - the Australian study. Patterson, J.C. (1991). Psychometric evaluation In: RS Jensen (Ed.) Proceedings of the 4th techniques in aerospace medicine. In: Neurological, Symposium of Aviation Psychology. Columbus; Psychiatric and Psychological Aspects of Ohio State University Press. Aerospace Medicine. AGARD-AG-324. Neuilly Thomas, B. & Joseph, C. (2005). Personality traits Sur Seine. and psychological test taking response style Picano, J.J. (1991). Personality types among indices in aircrew. Aviation, Space and experienced military pilots. Aviation Space and Environmental Medicine, 76, 3, Section 1, 227. Environmental Medicine, 62, 517-520.

18 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 19-29 Mishra et al./ Emotional intelligence and impulsivity Clinical Psychologists (ISSN 0303-2582)

Emotional Intelligence, Impulsivity and Suicidal Ideation of College Students

1Nishi Mishra, 2Sangeeta Yadav, 3V. K. Moudgil, 4Updesh Kumar

Studies have investigated the correlation of suicidal ideations in adolescents with a host of variables like anxiety, depression, alcohol abuse and impulsivity. Despite increasing evidence of the role of emotional intelligence in mental health and social adjustment of the individual, very few studies have examined the specific relationship between emotional intelligence, impulsivity and suicidal ideation. The present study was conducted to explore the relationship among the above three variables. Data were collected on 246 graduate students (122 males and 124 females) from the graduate colleges of Haryana. To measure the above mentioned variables three tools were used i.e. Adult Suicidal Ideation Questionnaire, Emotional Intelligence Scale and Neuroticism subscale of NEO- PI-R. Data were analyzed using descriptive statistics, correlation, t-test and regression analysis. Results revealed a significant negative correlation between suicidal ideation and emotional intelligence. Significant gender differences were obtained on impulsivity. Stepwise Regression Analysis revealed that emotional intelligence alone contributed to 34% of the variance in suicidal ideation.

Keywords: Emotional intelligence, suicidal ideation, , impulsivity, adolescents

Suicidal ideation refers to having thoughts hopelessness, helplessness, anxiety etc. about suicide. The range of suicidal ideation may Suicidal ideation is one of the leading causes vary, from fleeting to detailed planning, role- of death among adolescents and adults and playing and unsuccessful attempts. Suicidal thoughts about killing oneself are relatively ideation is a known risk factor for suicide attempt common during adolescence. The frequency of which in turn increases risk for completed suicide suicidal ideation is generally higher than attempts, (King, 1997). Some authors believe that it is not ranging from 21.1% to 28.8% lifetime prevalence abnormal to have such thoughts at one time or in adolescents (Andrews & Lewinsohn, 1992; another during the course of a lifetime. A healthy Fergusson, Woodward & Horwood, 2000; personality, however, quickly dismisses such Garisson, Addy, Jackson, Mckeown, & Waller, destructive thoughts as an unacceptable 1991; Harkavy-Friedman, Asnis, Boeck, & Difiore, alternative to life. But suicidal ideation is 1987).Various researchers (Latha, Bhat, & considered abnormal when the frequency of its D’Souza, 1996; Siwach & Gupta, 1995; Adityanjee, occurrence is more than two to three times in a 1986) indicated that young people are a vulnerable week and these thoughts interfere with the population, who struggle to cope with stressful individual’s day to day life, especially when these situations. According to police records of India thoughts are associated with depression, (National Crime Records Bureau, 2006), the suicide

1, 2,4Defence Institute of Psychological Research, Lucknow Road, Timarpur, Delhi-110 054, Department of Psychology, 3Govt. Post-Graduate College, Karnal, Haryana

19 Mishra et al./ Emotional intelligence and impulsivity rate for youths in 2006 was 10.5 (per 100,000) and parents (Lopes, Salovy, & Straus,2003). the rate for total population in the country Those who are psychologically healthy or remained around the same from 1996 to 2006. have good mental health are less affected by The rate of suicidal ideation among suicidal ideation or have less suicidal tendencies. adolescents is most because this stage is very The relationship between maladjustment and crucial and is considered as a period of turmoil, emotional intelligence is negative in nature. This storm and stress (Hall, 1904). At this stage, finding can be easily explained on the basis of the numerous changes, both psychological and fact that individuals, who are emotionally mature physiological occur and one’s socio-cultural and stable with their surroundings experience environment as well as factors within an individual lesser number of suicidal ideations (Bindu & make him or her vulnerable to suicidal thoughts Thomas, 2006). In a cross-sectional laboratory- or ideation and ultimately to suicidal attempt. based study, Cha and Nock (2009) reported emotional intelligence as a protective factor for Emotional Intelligence and Suicidal both suicidal ideations and attempts among Ideation adolescents at risk. There is some preliminary evidence to The term emotional intelligence or EQ refers suggest that some forms of emotional intelligence to abilities involved in the processing of emotional may protect people from stress and lead to better information: perceiving emotions, using emotions adaptation. While others suggest that adolescents to facilitate thinking, understanding emotions and who say that they are good at managing others’ regulating one’s own emotions and emotions of emotions (MOE) tend to have more social support. others (Mayer & Salovey, 1997). EQ is considered (Ciarrochi, Chan & Bajgar, 2001). Such increased as a positive trait that is positively related to support may help protect these people from coping strategies which is an important depression and suicidal ideation (Kalafat, 1997). determinant of an individual’s physical and Perception of emotions plays an important role in psychological well-being in response to negative stress-mental health relationship. People who are or stressful life events (Lazurus, 2000). Goleman poor at perceiving their emotions might actually (1995) stated that students who have emotional be less sensitive to the effects of stress. Similarly, competency can better deal with the pressure of a tendency not to think about thoughts and peer politics, the higher demands required for feelings, or low psychological mindedness, is academics, and the temptations of alcohol, drugs associated with lower anxiety, depression and and sex. It was also noted in the findings of Palmer, paranoia and with higher self esteem (Farber, 1989; Donaldson & Stough (2002) that emotional McCallum & Piper, 2001). intelligence was moderately correlated with psychological well-being. Higher EQ has also been Impulsivity and Suicidal Ideation found to be related to willingness to seeking professional and non-professional help for Impulsivity or impulsiveness is a type of personal emotional problems, depression and human behaviour characterized by the individual suicidal ideation (Ciarrochi & Deane, 2001). In one to act on impulses rather than thought. Impulsivity recent study, college students who had higher is also referred as cognitive tempo. Beautrais scores on an ability measure of emotion regulation (2004), Tosh et al. (2005) have compared the reported having more positive relationship with personality traits of suicide attempters with those others, less conflict and antagonism in their of suicide completers and reported that suicide relationship with a close friend, and greater attempters were higher in neuroticism and companionship, affection, and support from their openness and lower in agreeableness and

20 Mishra et al./ Emotional intelligence and impulsivity conscientiousness. Within the broader domain particularly young men, are less likely to seek of personality, impulsivity tends to be aligned with support when mentally disturbed than women less adaptive traits such as psychoticism (Biddle, Gunnell, Sharp et al. 2004). However some (Eysenck, Barret, Wilson & Jackson, 1992; studies indicate the opposite findings that women Zuckerman, 1979) or low conscientiousness report higher rates of suicide attempts and ideation (Costa & McCrae, 1992). Impulsivity also plays than do man (Andrews & Lewinsohn, 1992; an important role in understanding and diagnosing Fergusson, Woodward, & Horwood, 2000; various forms of psychopathology. There have Garrison et al., 1991). Differential risk across been considerable amount of researches exploring genders may be accounted for, in part, by higher how impulsivity relates to a range of problems. prevalence of depression and sexual victimization These include substance misuse (Dom,Wilel, among women (Lewinson, Hops, Roberts, Seely, Hulstijn,Vanden, & Sabbe, 2006), dyslexia (Baker & Andrews, 1993; Polusney & Follette, 1995), and & Ireland, 2007), self-injurious behaviour (Raust higher substance use disorder (SUD) prevalent et al., 2007) anger and psychopathy (Jackson, among men (Johnston, O’ Malley, & Bachman, Neumann, & Vitacoo, 2007). It is clear that 1991). A study carried out by Ireland & Archer impulsivity is considered relevant to a range of (2008) reveals that impulsivity does not present social and individual problems. Mann, Waternaux, in a uniform fashion between sexes. Impulsivity Hass, & Malone (1999) have found in their study has been used as a mediating variable describing that in majority of the subjects, the suicide attempt sex differences in aggression (Campbell, 2006). was impulsive in nature, which indicates that this Emotional problems and involvement in personality trait is an important determinant of delinquent behaviour have been reported as suicide. In a recent review Brezo, Paris, and Turecki important predictors of ideation for females, while (2006) find that hopelessness, neuroticism and employment problems have been reported as the extraversion are related to suicidal ideation, most potent predictor for males (Simons & suicide attempts and suicide completions. Murphy, 1985). A study done by Kashden, Fremouw, Adolescence is the age where an individual Callahan, and Franzen, (1993) on nonsuicidal and faces problems in every aspect of life i. e. problem suicidal adolescents inpatients indicates that in social adjustment either in family or in peer suicidal inpatients are characterized by greater group, confusion regarding identity, problems impulsivity, hopelessness, and depression. regarding choosing an appropriate vocation, physical as well as psychological changes. All Gender differences and suicidal ideation these can create anxiety, depression, and feeling of inferiority, eventually leading to substance Gender of a person may have significant abuse, suicidal ideation and ultimately an attempt impact on his or her personality as well as on for suicide. Emotional intelligence and impulsivity behavioural characteristics. Correlation between are those aspects of personality that affect the suicidality and impulsivity appeared greater in mental health as well as social adjustment and males than females. Since male suicide attempters functioning of the individual. The present study are more likely to eventually commit suicide than is an attempt to explore the relationship between female suicide attempters. (Horesh, Gothelf, Ofek, emotional intelligence, impulsivity and suicidal Weizman, & Apter, 1999). Stewart, Donaghey, ideation. The following hypotheses were Deary & Embeier (2008), found that men scored formulated: slightly higher on suicidal thoughts. The (i) There would be a negative correlation psychological pathways may be different in men between emotional intelligence and suicidal then women. A recent study found that men, ideations among college students.

21 Mishra et al./ Emotional intelligence and impulsivity

(ii) A positive correlation is expected between The maximum and minimum possible score is 165 suicidal ideation and impulsivity. and 33 respectively. (iii) There would be gender differences on emotional intelligence, impulsivity and suicidal NEO-Personality Inventory-Revised (Costa and ideation. McCrae, 1992)

Method 8-items of NEO-PI-R (Neuroticism) have been Participants used for measuring impulsivity. The items are rated on a 5-point scale (1=strongly disagree and Sample comprised 246 college-going 5=strongly agree). The internal consistency for graduate students (122 male and 124 female) of individual facet scales of the inventory range from Haryana in the age group of 19-24 years, with a 0.56 to 0.81, and for the domain scales the mean age of 21.5 yrs. coefficient ranges from 0.86 to 0.92 (Costa, McCrae, & Dye, 1991). Measures Procedure Adult Suicidal Ideation Questionnaire (Reynolds, 1991) Data were collected on 250 college students of Haryana by administering the questionnaire The questionnaire has 25-items, which are comprising three scales i.e. Emotional Intelligence, rated on a 7-point scale (6= almost every day to Adult Suicidal Ideation and the Impulsivity 0= I never had this thought). In the questionnaire subscale of NEO-PI-R. After establishing the items are not arranged in order of severity. (Item rapport, students were first asked to fill the no. 2, 3, 4, 5, 15, and 25, are critical items which are demographic details and then to fill the specific to actual thoughts and plans for suicide. questionnaire completely. While filling the Cases in which two or more of these critical items questionnaire no time limit was given. Doubts, if are endorsed are to be viewed as serious any, were clarified. It was ensured that testing regardless of the raw score on the scale). Maximum conditions remain the same for both the groups possible raw score is 150. Increased raw score of students. (i.e. males and females) The following indicates numerous and/or more frequent suicidal ethical standards were adhered to while carrying thoughts. out the study:

Emotional Intelligence Scale (Schutte et al., 1. The students were briefed about the purpose 1998): of the study. This is a 33-item scale, rated on a 5-points 2. Only those students were included who (1=strongly agree and 5=strongly disagree; item consented to participate in the study. nos. 5, 28, and 33, are scored in reverse manner). 3. They were assured about confidentiality of Scores on 33-item measures is correlated with their responses. alyxithymia, attention to feelings, optimism, and 4. Students who were not willing to fill up the impulse control. Out of 33-item, 13 items are related entire questionnaire were allowed to leave. to appraisal and expression of emotions, 10 items 5. When the group had filled up the are related to regulation of emotions and remaining questionnaire, they were debriefed before 10 items are related to utilization of emotions. An leaving. internal consistency analysis showed a Cronbach’s alpha of 0.90 for the 33-item scale. Responses were scored for each scale and

22 Mishra et al./ Emotional intelligence and impulsivity data were analysed using the SPSS (Statistical impulsivity and suicidal ideation. In the total package for Social Sciences-10 Version). sample, a great variability in scores for both males

Results and females on suicidal ideation can be seen. Scores on suicidal ideation dimension are In order to know the distribution of the found to be positively skewed as can be seen in obtained scores of the college students on the Fig. 1. Thus, nothing specific can be said in three scales, data were analyzed for descriptive statistically significant terms regarding the statistics. Table-1 presents the results of the presence or absence of suicidal ideations in descriptive statistics. For overview of the absolute terms among the male and female inference that may be drawn on the basis of students ( The findings are thus supposed to be descriptive statistical analysis, it is pertinent to viewed with caution). Table 2 shows gender wise descriptive Table 1. Mean and standard deviation values for statistics and ‘t’ values showing significance of overall sample on emotional intelligence, suicidal difference between male and female adolescents ideation and impulsivity (N=246) on emotional intelligence, suicidal ideation and impulsivity. On emotional intelligence, the mean Variable Mean SD of males is less than that of females, indicating that females are better in understanding of Emotional Intelligence 124.2398 15.4459 emotions than males. On impulsivity, the average Suicidal Ideation 26.1382 28.3148 score of males is higher than females, thus revealing their impulsive bend of mind. On suicidal mention here that the maximum attainable score ideation, the higher mean values for females for emotional intelligence was 165 and minimum indicate that they have more suicidal thoughts as possible score was 33. The maximum score for compared to their counterparts. On emotional suicidal ideation was 150 and for impulsivity intelligence, a greater variability can be seen in maximum possible score was 40 while minimum the scores of males as compared to females, possible score was 1. whereas, on impulsivity the variation in scores is Table 1 exhibits the descriptive statistics minimal. On emotional intelligence and suicidal (mean and standard deviation) for total sample ideation, a non-significant difference in scores (N=246) on three variables: emotional intelligence, Fugure 1. Bar diagram of over all samples for Figure. 2 Bar diagram of males suicidal ideation suicidal ideation scores

23 Mishra et al./ Emotional intelligence and impulsivity

Table 2. ‘Mean, SD snd t’ values for gender differences on emotional intelligence,suicidal ideation and impulsivity

Emotional Intelligence Impulsivity Suicidal Ideation

Mean SD t Mean SD t Mean SD t Male 123.14 17.02 24.80 3.88 24.56 24.59 -0.870 -1.107 0.405*** Female 125.32 13.70 23.20 3.50 27.69 31.58

***p <0.001 Table 3.Correlation between emotional intelligence, suicidal ideation and impulsivity

Variables Emotional Intelligence Suicidal Ideation Impulsivity

Emotional Intelligence - Impulsivity -0.185** - Suicidal Ideation -0.094 0.109 -

**p <0.01 Table 4. Regression analysis for emotional intelligence, impulsivity and suicidal ideation

Variable R R2 Adjusted R F Unstandardized Excluded entered Coefficient Variable â SE Emotional 0.185 0.034 0.0302 8.635 68.243 14.439 Impulsivity Intelligence

Dependent variable: Suicidal ideation Figure 3. Bar diagram of over all samplesfor was obtained for males and females; whereas, on suicidal ideation impulsivity, a significance difference in scores was obtained. Males were found to score higher than females on impulsivity. On suicidal ideation, the variability of scores is more than mean values for females. This can be seen in Figure 2. A similar pattern is seen among males, although the difference is less as can be seen in Figure 3. Table 3 shows correlation between emotional intelligence, suicidal ideation and impulsivity. It reveals a significant negative correlation between

24 Mishra et al./ Emotional intelligence and impulsivity suicidal ideation and emotional intelligence, i.e. are concentrated on the right side (positive higher the suicidal ideation, lesser is the emotional skewness). The possibility of social desirability intelligence. A negative though non-significant and response-biasness cannot be ruled out. Mean correlation was found between emotional of impulsivity scores reveal moderate level of intelligence and impulsivity, Similarly non- impulsivity. significant correlation was obtained between On emotional intelligence, no significant suicidal ideation and impulsivity. difference was found between the mean scores of Table 4 reveals the results of regression males and females (Table 2) thus revealing their analysis. The R value reveals that suicidal competency to express their own and appraise ideation is best predicted by emotional other’s emotions effectively. Obtained results are intelligence, with the latter contributing to 34% of not in line with the findings of study reported by variance in test scores. Aquino, 2003; Argyle, 1990; Lafferty, 2004; Tapia & Marsh II, 2006; Trobst, Collins, & Embrel, 1994 Discussion wherein women were found to be more emotionally expressive than men, that they understand The psychological literature on suicide is emotions better and that they have greater ability steadily getting more refined. Researchers have as regards to certain interpersonal skills. shown that emotional intelligence affects stress Mean scores on impulsivity were however level and subjective well-being and those who higher for males (Table 2) suggesting that most of are high on emotional intelligence would be able the male college graduates are impulsive in nature. to protect themselves from the adverse effect of Differences in socialization patterns and parenting stress, hopelessness, reported thoughts about may be cited as one possible reason. Cognitive suicide and impulsivity. Similarly, various studies and/or motor deficits early in life may be the indicate that majority of the subjects who attempt second possible cause. suicides are impulsive in nature. In the present Females were found to be more prone to study, effect of emotional intelligence and suicidal thoughts and suicidal acts (Table 2). It impulsivity was examined on suicidal ideation of support the findings reported earlier by male and female adolescent college-graduates. researchers who found higher rates of suicide Table gives the value of descriptive attempts and ideation in women as compared to statistics for 246 subjects for emotional men (Andrenes & Lewinsohn, 1992; Fergusson intelligence, suicidal ideation and impulsivity. et al., 2000; Garrison et al. 1991). Differential risk From this table one can observe that mean scores across genders may be accounted for, in part, by of respondents on emotional intelligence is quite higher prevalence of depression and sexual near the maximum possible score (i.e.165) which victimization among women (Lewinsohnet al. shows that the level of emotional intelligence of 1993; Polusney & Follette, 1995), and higher most of the respondents is above average. In other substance use disorder (SUD) prevalence among words they give considerable attention to their men (Johnston et al. 1991). The psychological feelings and can properly express their emotions. pathways may also be different in men and women. Standard deviation indicates less variability But the standard deviation of mean scores on among scores revealing that there are very few suicidal ideations is more than mean in both male respondents who have scored at either extreme. and female which may be due to skewness in Mean scores on suicidal ideation indicates scores (see Figure 2 and 3). Distribution of scores that respondents do experience suicidal ideations is not normal for both the genders. Most of the occasionally. Too much variability among the scores are concentrated on the left side of the scores can be seen in Fig. 1 where all the scores axis (positively skewed) and very few scores are

25 Mishra et al./ Emotional intelligence and impulsivity distributed on the right side. Through this it can (iii) Previous studies have indicated gender be inferred that most of the respondents have differences on emotional intelligence but as chosen those responses which were socially per our study no such differences were desirable by reporting lesser number of suicidal found. This finding needs further ideations. exploration and replication. Significant gender differences were found on impulsivity thus supporting the findings of (iv) In the present study a subscale of NEO-PI- Ireland and Archer (2008) that impulsivity does R was used for measuring impulsivity not present in a uniform fashion between sexes. comprising only 8 items. In future one can Impulsivity has been reported as a mediating use a questionnaire that is specifically variable describing sex differences in aggression designed for measuring impulsivity. (Campbell, 2006). In correlational analysis (Table 3) a highly (v) The findings of the study reveal a significant negative correlation between suicidal significant negative correlation between ideation and emotional intelligence reveals that emotional intelligence and suicidal emotionally intelligent persons experience less ideations. These findings can be considered suicidal ideations. Emotional intelligence is a while designing certain counseling positive trait which is positively related to coping programs for depressed adolescents strategies (Lazarus, 2000). Emotionally intelligent experiencing suicidal ideations by persons are better in handling the relationship so enhancing their emotional intelligence, they have sufficient social support. Such positive traits and by teaching them positive increased support may help protect these people coping strategies. from depression and suicidal ideation (Kalafat, 1997). The correlation between suicidal ideation References and impulsivity though positive was found to be non-significant. Adityanjee, D. R. (1986). Suicide attempts in India: Multiple Regression Analysis (Table 4) cross cultural aspects. International Journal of shows that 34% of the variance in suicidal ideation Social Psychiatry, 32, 64-73. is caused by emotional intelligence. Andrews, J. A., & Lewinson, P. M. (1992). Suicidal attempts among older adolescents: Prevalence Limitations and Future perspectives and co-occurrence with psychiatric disorder. Journal of the American Academy of Child & The present study has tried to capture the Adolesecent Psychiatry, 31, 655-662. possible correlates of suicidal ideations among Aquino, A. E. (2003). Diferencias de Ge‘nero y Edad college going students. But still this study has its en la Inteligencia Emocional de un Grupo de own limitations such as- Internautas. [Gender differences and Age in a Group of Web Browsers’ Emotional Intelligence]. (i) The results can not be generalized to Unpublished Thesis. Universidad Inca Gracilazo populations of other age-groups except de la Vega. Faculted de psicologli‘a Ciencias adolescent/college going students. Sociales. Lima-Peru‘. (ii) The variability in scores on suicidal Argyle, M. (1990). The psychology of interpersonal ideations can be reduced by choosing a tool behaviour. Harmondsworth, UK : Penguine. where lesser chances of social desirability Baker, S. F. & Ireland, J. L. (2007). The link between are likely to occur. dyslexic traits, executive functioning,

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29 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 30-37 Kashyap et al./ Visuo-motor Tests Clinical Psychologists (ISSN 0303-2582) Standardization of Tests of Visuo-spatial Construction and Mental Rotation 1Himani Kashyap, 2Shobini L. Rao, 3Keshav Kumar J., 4B. Indira Devi

The aim of the present study was to establish normative data for tests of visuo-spatial construction. The tests studied were the Bender Gestalt Test, the Stick Construction Test, and the Three-Dimensional Block Construction Test. The sample consisted of 120 normal school-educated subjects, of both genders, between the ages 16 and 50. 25% of the total sample was re-tested after a period of six to eight weeks to establish test-retest reliability. Normative data consisting of percentile scores were derived for those test variables which were found to be reliable. Although validation of these tests was attempted using a sample of frontal lesion cases and parietal lesion cases, the small sample of parietal lesion cases necessitates further work to fully establish the validity.

Keywords: normative data, parietal lobe, visuospatial functions, Bender Gestalt Test, Stick Construction Test, Block Construction Test

Visuospatial construction involves the ability information they can provide. No matter how to assemble objects or produce organized sensitive these tests might be, they still leave “constructions” referred to as constructional some functions untouched and do not discriminate praxis (Manning, 2003). The constructions may very well between subjects with and without be either two-dimensional (drawing or lesions (Lezak, 1995). Baiyewu et al (2005) constructing simple stick patterns) or three- comment that the popularity of drawing-based dimensional (assembling patterns of blocks). visuo-constructional tests relates to their ease of Constructional abilities are most commonly administration, relatively objective scoring, and assessed on drawing tests that involve copying presumed cultural invariance. However, the or free drawing. Copying tasks such as the Bender performance of persons with low education on Gestalt Test (BGT) or the Complex Figure Test, these tests cannot be unambiguously interpreted. cube drawing and free drawing tasks like the Draw- These authors have reported evidence for literacy- a-Person Test are often used to assess related low graphomotor (drawing-based) constructional abilities. Some authors point out function, which presumably affects performance that copying and free drawing cannot be independent of any specific visuospatial considered analogous since free drawing involves dysfunction. Even when the response does not imaginative and organizational abilities (Grossi & involve writing letters, words, or numbers, the Trojano, 1999). The quick and easy administration requirement of holding a pencil to write or draw is of the BGT makes it one of the most frequently in itself perceived as anxiety provoking for used tests (Lezak, 1995). The diagnostic accuracy individuals with no formal schooling. Performance of the BGT in detecting brain damage is as high on such tests may therefore not reflect true visuo- as 82% (Heaton, Baade & Johnson, 1978). spatial constructive ability of the individual and However, although drawing tests are rich put him/her at a disadvantage while interpreting sources of data, they have limits to the amount of the scores, thus resulting in a barrier to

1,2,3Department of Mental Health and Social Psychology, NIMHANS, Bangalore, 4Department of Neurosurgery, NIMHANS, BangaloreCorrespondence: First author: [email protected]

30 Kashyap et al./ Visuo-motor Tests performance and complication in interpretation al, 2005). In order to rule out such false positives, of results. Hence there is a need for non- it is necessary to use tests that are free of an graphomotor, or non-drawing-based measures of education bias, and have norms developed for constructive ability the specific population in question. Manning (2003) comments that constructing Currently, Indian norms are available for a and copying patterns with sticks are rapid and battery of frontal lobe and temporal lobe tests less demanding tasks, and that although norms (Rao, Subbakrishna & Gopukumar, 2004). Tests are not readily available, such tasks have such as the BGT are being used in routine clinical qualitatively proved sensitive to constructional practice with Western norms. Among the other impairment despite their simplicity. Baiyewu et al visuospatial construction tests, the Rey’s (2005) also concluded that the stick construction Complex Figure Test (copy condition) (Rao, task is a reasonable measure of visuo- Subbakrishna & Gopukumar, 2004) and the Koh’s constructional ability in older cohorts with very Block Design Test (Bhatia, 1955) have been limited educational exposure and literacy. standardized on the Indian population. A version Another non-graphomotor task involves of the Stick Design Test has been validated on assembling blocks in three-dimensional patients with epilepsy (Kavitha, 2005), however constructions. The Three-Dimensional Block as a test of memory rather than construction. At Construction Test is more sensitive than a two- present, Indian norms are not available for any dimensional measure such as WAIS Block Design other visuo-constructive tests. test, with a higher number of patients falling in Hence in order to assess visuospatial the impaired range on the former (Spreen construction, it is necessary to develop norms &Strauss, 1988). In addition, the three- for a set of tests using the Indian population, and dimensional block construction test discriminates validate these tests on patients with parietal lobe between patients with moderate and severe brain lesions so that these tests can be used effectively impairment which has been attributed to its in Indian conditions. increased task complexity (Lezak, 1995). The present study is an attempt to Grossi and Trojano (1999) point out that standardize a set of tests to assess visuospatial drawing, assembling and building cannot be construction. The objectives are to establish the considered equivalent because they rely on reliability and validity of the tests and then various cognitive functions (attention, reasoning, generate norms in the form of percentile scores motor, perceptual and visuospatial skills) to for those tests which are reliable and valid. differing extents. There has been contrasting data regarding correlations between drawing, three- Method dimensional construction and visuospatial tasks, due to which it is recommended that they be tested The sample included 120 normal school- separately. educated subjects from the community consisting Performance on neuropsychological tests is of 60 males and 60 females. Of the 60 in each gender influenced by socio-demographic variables such group, 30 subjects were in the age range 16-30 as age, education and gender of the subject (Rao, years and 30 subjects in the age range of 31-50 Subbakrishna & Gopukumar, 2004). Formal years. The mean age of the sample was 32.23 years education and literacy influence results on and the mean education was 7.62 years. 25% of visuospatial or visuoconstructive tasks (Danisilio the normal sample, i.e. 32 subjects consisting of 8 & Charamelo, 2005), with low literate subjects subjects from each group was re-tested after a performing poorly on drawing-based tests time period of 6 to 8 weeks to establish test-retest independent of visuospatial deficits (Baiyewu et reliability. In addition, a clinical sample consisting

31 Kashyap et al./ Visuo-motor Tests of 14 frontal lesion cases and 5 parietal lesion BGT errors. cases (with right or left unilateral lesions) drawn Stick Construction Test (Buters & Barton, from the in-patient and out-patient services of 1970) - This test assesses two-dimensional the National Institute of Mental Health and Neuro visuospatial construction. It includes a rotation Sciences (NIMHANS) was included. The age condition as well as a standard copy condition. range was 16-50 years and education range was This ten-item test is first administered as a copying 1-10 years of education. The mean age of the clinical task. The patient is given four wooden sticks group was 34.06 years and the mean education (approximately 5 inch long and 1/4 inch wide with was 8.81 years. The clinical sample was earlier 1/2 inch blackened tip) and asked to copy the planned to include 15 patients with frontal lesions examiner’s model exactly. After the ten designs and 15 with non-frontal cortical lesions. However are copied, the rotation (or reversal) condition is although 16 frontal lesion cases and 15 parietal administered, in which the patient is asked to lesion cases were tested, only 14 frontal lesion construct his pattern in the reverse of the cases and 4 parietal lesion cases were available in examiner’s model. Of the ten patterns in the copy the final analysis for the following reasons: 2 condition, only six are used in the rotation frontal lesion cases and 8 parietal lesion cases condition since the other four look the same as did not fulfill age and education criteria. The data the copy on reversal. The time taken for the of 3 parietal lesion cases was incomplete since construction of each pattern, as well as the number the Bender Gestalt Test and Line Bisection Test of errors, is noted and totaled, on each condition could not be administered on 2 of the patients separately. This generates four variables – time with visual impairments. The third patient did not taken for copy condition (Sticks Time 1) and the complete the assessments as she did not keep rotation condition (Sticks Time 2); as well as the second appointment. number of errors on the copy condition (Sticks Errors 1) and the rotation condition (Sticks Errors Tests of Visuo-spatial Construction 2). Test of three-dimensional block construction Bender Gestalt Test (Spreen and Strauss, (Spreen & Strauss, 1988) This test measures 1988) The BGT is a test to assess two- visuo-constructional ability by how well dimensional visuospatial construction. It consists constructions in three-dimensional space are of nine geometric designs (numbered A and 1-8) copied. The test consists of three block models presented sequentially to the subject whose task of increasing complexity using 6, 8 and 15 blocks is to reproduce them on a single blank sheet of from an assortment of blocks on a tray. A total of paper of A4 size. Scoring was done using the Lacks 29 individual blocks of different shapes and sizes scoring system. Lacks’ (1984, 1999) scoring are used. The different kinds of errors are noted – system for brain dysfunction employs a clinical Omission, Addition, Substitution and inspection method which was designed for Displacement. The time taken for the three models adolescents and adults. It involves examining a (Blocks Time 1, Blocks Time 2 and Blocks Time 3), protocol for the presence of each of twelve as well as the total number of errors made on each indicants-Rotation, Overlapping Difficulty, model (Blocks Errors 1, Blocks Errors 2, Blocks Simplification, Fragmentation, Retrogression, Errors 3) are variables considered for analysis. Perseveration, Collision or Collision Tendency, Impotence, Closure Difficulty, Motor Results and Discussion Incoordination, Angulation, Cohesion. The total number of errors made by the subject was the Test retest reliability was calculated with Karl variable considered for analysis, referred to as Pearson’s Product-Moment Method and the

32 Kashyap et al./ Visuo-motor Tests correlation co-efficients are given in Table 1. minus one standard deviation, that is, the 15th percentile is chosen as the cut-off to identify Table 1. Reliability co-efficients of the test deficits. This is a liberal estimate of the deficit as ______variables it is 1 standard deviation above or below the mean Variables r (Rao, Subbakrishna and Gopukumar, 2004). The ______cut-offs at the 15th percentile are highlighted for BGT errors 0.66** each variable in the table. Sticks Time 1 0.59** Table 3 gives the demographic details, Sticks Errors 1 - location of lesion and test scores of all the clinical Sticks Time 2 0.41* subjects on the test variables (Scores falling in Sticks errors 2 0.49** the impaired range are highlighted for each Blocks Time 1 -0.05 patient). All patients, except 3 with frontal lesions Blocks Errors1 - and 2 with parietal lesions evince impairments on Blocks Time 2 0.25 at least one of the variables. It is evident from the Blocks Errors 2 - table that several patients with frontal lesions have Blocks Time 3 0.60** impairments on the test variables, and also that Blocks Errors 3 0.09 the ones who do evince impairments have mostly right-sided lesions. The involvement of the frontal ** p < 0.01 , * <0.05 lobe in constructional tasks is described in the literature (Grossi &Trojano, 1999; Makuuchi et al, The variables which had significant test- 2002). Construction is known to be a retest reliability co-efficients were chosen for predominantly right hemisphere function although further analysis. Percentile scores and cut-off left hemisphere and bilateral involvement have scores were derived for these variables, namely- also been reported (Critchley, 1953; Hecaen BGT errors, Stick Construction Time 1 (total time &Albert, 1978; Manning, 2003; Vanderploeg, taken for the copy condition), Stick Construction 2000). Thus hemispheric laterality of the lesion Time 2 (total time taken for the rotation condition), may be an important determinant of deficits in Stick Construction Errors 2 (total errors on the visuoconstructive abilities. rotation condition) and Block Construction Time The sample of parietal lesion cases is too 3 (total time taken for the 15-block model). Most small to derive any valid conclusions. Regardless of the subjects have obtained a score of zero in of this, a few hypotheses may be generated for both test and re-test conditions in the error scores further study. It is clear that impairments are found of Stick Construction copy condition and Block on the non-graphomotor measures more than the Construction Models 1 and 2. In other words, the graphomotor measure for both clinical groups. error scores are unable to discriminate between This might indicate that the non-graphomotor subjects who perform well and those who do not measures are more sensitive, which is corroborated (Singh, 1997). This may be explained by the by the existent literature (Baiyewu et al, 2005; simplicity of the tasks in the copy condition of Manning, 2003). Furthermore, of the two parietal the Stick Construction Test and Model 1 and 2 of lesion cases who have impairment on the tests, the Block Construction Test. both have impaired scores on the test of three- The mean, standard deviation and percentile dimensional construction. This may suggest that scores for the test variables are given in Table 2. tests of three-dimensional construction are Based on the percentile scores the cut-off scores particularly sensitive to parietal visuoconstructive to discriminate between the normal and clinical dysfunction. This is in keeping with the view sample were also derived. The mean plus and advocated by several authors (Critchley, 1953;

33 Kashyap et al./ Visuo-motor Tests

Table 2. Mean, standard deviation and percentile scores for the test variables (N=120)

Bender Stick Stick Stick Block Percen- Gestalt Construction Construction Construction Construction tiles Test Errors Test Time 1 Test Time 2 Test Errors 2 Test Time 3

5 4 168 210 3 113 10 3 144 162 3 96 15 3 137 142 3 87 20 3 116 127 2 84 25 3 108 119 2 79 30 3 101 111 2 74 40 3 92 94 1 64 50 3 84 84 1 61 60 2 73 77 1 56 70 2 67 68 1 53 75 2 65 60 0 51 80 2 61 52 0 49 85 2 58 48 0 45 90 1 51 44 0 43 95 1 44 27 0 36 Mean 2.5 93 96.33 1.30 67.11 SD 0.85 47.38 56.32 1.11 27.30 ** p < 0.01, * p < 0.05 Lezak, 1995; Spreen & Strauss, 1988) that patients 2005; Danisilio & Charamelo, 2005), graphomotor who respond moderately well to drawing and stick tests, which require the subject to use a paper construction tasks display gross abnormalities in and pencil, pose several difficulties for illiterate three-dimensional construction tasks. or low-literate subjects. Subjects do not have Table 4 gives the inter-correlations amongst difficulty copying similar designs using sticks; the test variables. It is clear from the table that the hence the processes involved in graphomotor as time scores of Stick Construction Test and Block opposed to non-graphomotor measures have been Construction Test are highly correlated. This may hypothesized to be different (Danisilio be due to the fact that both these tests are non- &Charamelo, 2005; Grossi &Trojano, 1999). The graphomotor measures as opposed to the BGT, correlations among the non-graphomotor tests which is a graphomotor (drawing) test. As found in the present study support this demonstrated by several authors (Baiyewu et al, hypothesis.

34 Kashyap et al./ Visuo-motor Tests

Table 3. Demographic details, location of lesion and test scores of clinical subjects on the reliable test variables

Sl. Age Education Sex Location BGT Sticks Sticks Sticks Blocks No. of lesion Time 1 Time 2 Time3 Errors 2

12510th std F Right frontal lobe 2 115 86 1 151

2356th std M Right frontal lobe 3 218 115 0 162

3384th std F Right frontal lobe 3 114 125 2 78

44010th std F Left frontal lobe 2 197 71 1 75

54710th std M Right frontal lobe 2 128 75 1 73

6419th std M Left frontal lobe 2 104 121 3 62

73310th std F Right posterior 8 410 140 3 266 frontal lobe 84010th std M Right frontal lobe 4 145 193 3 89

92510th std M Right frontal lobe 3 62 159 0 54

10 35 4 th std F Left frontal lobe 2 138 225 2 97

11 30 10 th std M Right frontal lobe 2 76 82 0 59

12 38 9 th std M Right frontal lobe 2 60 73 1 61

13 27 10 th std M Left posterior 2 66 64 1 65 parietal lobe

14 42 9 th std M Right parietal lobe 2 116 84 0 78

15 30 10 th std M Left parieto- 2 115 113 1 103 occipital area 16 25 9 th std F Left superior parietal 3 139 66 0 262

The Bender Gestalt Test error score is test, is likely to have significant difficulties with correlated significantly with the time score of the the BGT, as both these assess the function of copy condition in the Stick Construction Test. A two-dimensional construction. possible explanation for this is that a subject who The error score on Stick Construction rotation has difficulty on the Stick Construction Test copy condition is highly correlated with all the other condition and hence takes longer to complete the four variables namely, BGT errors, the two Stick

35 Kashyap et al./ Visuo-motor Tests

Table 4. Inter-correlations among the test variables

Variables BGT errors Sticks Time1 Sticks Time 2 Sticks Errors 2 Blocks Time 3

BGT errors 1 0.23* 0.08 0.22** 0.06

Sticks Time1 - 1 0.51** 0.31** 0.43**

Sticks Time 2 - - 1 0.44** 0.41**

Sticks Errors 2 - - - 1 0.36**

Blocks Time 3 - - - - 1

** p< 0.01, *p< 0.05 Construction time scores and the Block 35, 2, 111-118. Construction time score. This seems to suggest Baiyewu, O., Unverzagt, F.W., Lane, K.A., Gureje, O., that the function of mental rotation is correlated Ogunniyi, A., Musick, B., et al (2005). The stick with visuospatial construction. This is in keeping design test: A new measure of constructional ability [Electronic Version]. Journal of the with neuroimaging studies which have suggested International Neuropsychological Society, 11: that the posterior parietal cortex is involved in 598–605. both visuospatial construction and mental rotation Bhatia, C.M. (1955). Performance Tests of Intelligence (Alivisatos & Petrides, 1997; Manning 2003; under Indian Conditions. London: Oxford Zacks, Mires, Tversky & Hazeltine, 2002). University Press. Butters, N., & Barton, M. (1970). Effect of parietal Conclusion lobe damage on the performance of reversible The present study has established norms for operations in space. Neuropsychologia, 8, 205- tests of visuospatial construction and mental 214. Critchley , M. (1953). The Parietal Lobes. London: rotation, which have been found to be reliable Edward Arnold (Publishers) Limited. 8-19, 172- measures. However, one of the limitations of the 202, 309-310, 326-355, 391-405. study is the small sample of parietal lesion cases, Danisilio, S., & Charamelo, A. (2005). Constructional which necessitates further research to establish functions and figure copying in illiterates or low- the validity of these tests. Future research may schooled Hispanics [Electronic Version]. Archives validate these tests on a larger clinical sample. In of Clinical Neuropsychology, 20, 1105-1112. addition, these norms have been established only Heaton, R.K., Baade, L.E., & Johnson, K.L. (1978). for school-educated subjects between the ages Neuropsychological test results associated with 16-50. Establishing norms for subjects of older psychiatric disorders in adults. Psychological Bulletin, 85 (1), 141-162. age and higher education is also a significant need. Hecaen, H., & Albert, M.N. (1978). Human Neuropsychology. New York: John Wiley and References Sons. Kavitha, P.R. (2005). Development of a Alivisatos, B., & Petrides, M. (1997). Functional neuropsychological battery for the evaluation of activation of the human brain during mental mesial temporal lobe epilepsy. Doctoral thesis rotation [Electronic Version]. Neuropsychologia, submitted to NIMHANS (Deemed University),

36 Kashyap et al./ Visuo-motor Tests

Bangalore. (2004). NIMHANS Neuropsychology Battery- Lacks, P.B., Colbert, J., Harrow, M., & Levine, J. (1970). 2004 Manual. Bangalore: National Institute of Further evidence concerning the diagnostic Mental Health and Neuro Sciences accuracy of the Halstead Organic Test Battery. Singh, A.K. (1997). Tests, measurements and research Journal of Clinical Psychology, 26, 480-481. methods in behavioural Sciences (3rd edition). Lezak, M.D. (1995). Neuropsychological Assessment Patna: Bharati Bhawan (Publishers and (3rd edition). New York: Oxford University Press. Distributors). Makuuchi, M., Kaminaga, T., & Sugishita, M. (2003). Spreen & Strauss (1988). A compendium of Both parietal lobes are involved in drawing: A neuropsychological tests-administration, norms functional MRI study and implications for and commentary (2nd edition). New York: Oxford constructional apraxia [Electronic Version]. University Press. Cognitive Brain Research, 16, 338-347. Vanderploeg, R.D. (2000). The interpretation process. Manning, L. (2003) Assessment and treatment of In Vanderploeg, R.D. (Ed). Clinician’s guide to disorders of visuospatial, imaginal and neuropsychological assessment (2nd edition). constructional processes. In P.W. Halligan, U. London: Lawrence Erlbaum Associates. Kischka and J.C. Marshall (Eds) Handbook of Zacks, J.M., Mires, J., Tversky, B., & Hazeltine, E. Clinical Neuropsychology (pp. 190-193) Oxford: (2002). Mental spatial transformations of objects Oxford University Press and perspective [Electronic Version]. Spatial Rao, S.L., Subbakrishna, D.K., & Gopukumar, K. Cognition & Computation, 2, 4, 315-322

37 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 38-46 Nayar et al./ Narratives of wives Clinical Psychologists (ISSN 0303-2582) Narratives of Wives Living with Persons with Alcohol Dependence– Why Do they Stay in Violent Marital Relationships?

1Mahima Nayar, 2D. Muralidhar, 3M. N. Vranda, 4Pratima Murthy 5B.N. Gangadhar, 6A. Jagadish The purpose of the present study was to understand women’s reasons for staying on in abusive relationships, the coping strategies used when they chose to stay on, response of social network and how they cope with that response. The paper also elaborates on the expectations women had from a health set up, the problems they faced and their future plans. The clinical implications and directions for future research are offered.

Keywords: Persons with Alcohol Dependence, Violence, Wives, Narratives,

Violence or abuse against women is an age group with varying backgrounds (Orford, 1990). old, global and most common method of Most of the wives of PAD in the initial stages subjugating women particularly within marital life. negate the existence of violence and accept it as Its concealment and acceptance as something an inevitable, hoping that someday the situation that happens to women and its socio-cultural would improve. In studies with battered women, sanction is evident in most patriarchal societies. coping strategies are typically dichotomized as UN (1993) defined violence against women as “active versus passive”. Observable and any act of gender based violence that results in behavioral effects are categorized as “active” or is likely to result in physical, sexual or strategies, whereas unobservable cognitive or psychological harm or suffering to women. This emotional effects as “passive” strategies (Finn, includes threats of acts, coercion or arbitrary 1985). Others have classified battered women’s deprivation of liberty, whether occurring in public coping as “engagement” versus “dis- or private life. Wives of persons with alcohol engagement”. Active or engagement strategies dependence (PAD) face all these forms of violence tend to be associated with lower level of in varying degrees. psychological distress (Kemp et al., 1991). These Several studies have shown that spouses researchers have pointed out that use of of persons with alcohol dependence (PAD) “passive” strategies might reflect a battered present with significant rates of mental and woman’s deliberate choice based on her accurate physical problems including communication assessment of the situation and available options, problems, low social activity and poor marital as opposed to a deficiency in “active coping” satisfaction (Moos et al., 1990; Halford et al., skills. The cultural values and family norms 2001). The wives of PAD develop ways of dealing influence woman’s choices, prescribing a range with the concomitant stress, a coping behavior of coping strategies that are available or which seems to be rather uniform even though acceptable to them. In some cultures, leaving spouses of PAD are, of course, a heterogeneous the relationship might not be viable for many 1School of Social Sciences, Jawaharlal Nehru University, New Delhi; 2,3Department of Psychiatric Social Work; 4De-addiction Unit; 5Department of Psychiatry, NIMHANS, Bangalore, 6ABHAYA Hospital, Bangalore;Corespondence: [email protected]

38 Nayar et al./ Narratives of wives women because of religious or socio-economic Since the objective of the study was to constraints. For some, confronting their partners, understand women’s experiences in their own asserting their rights, or seeking outside words it was felt that there was a need to use assistance may mean going against their cultural qualitative methodology. This is because values and norms. A pressure to comply with qualitative research is a situated activity that collective welfare and family harmony over one’s locates the observer in the world. It involves an individual’s needs and rights, and to save the interpretative, naturalistic approach to the world. family’s face may be stronger in some cultures A well detailed, pre-determined methodology than others. Thus, some women may appear limits the agenda for research as in ‘forced choice’ “passive” in their victimization because of such situations. Often when researchers using the cultural prescriptions (Yoshihama, 2002). paradigm of the natural sciences claim to Another important concept related to coping understand and speak on the behalf of the groups is social support. With regard to the violence in that are studied, the community being researched particular, a number of studies have documented is usually silenced and variety is truncated into the relative dearth of social support among simple categories. In social constructionism, on battered women, as well as their reluctance to the other hand, the people are involved in access existing support networks both informal speaking about themselves (Shotter, 1993). and formal (Barnett et al.,1996; Dunham and Senn, Qualitative studies seek to convey the complex 2000). Coker et al. (2002) found that higher levels world of respondents in a holistic manner using of emotional support can modify the effect of ‘thick description’ rather than particular intimate partner violence on health and categories and variables. Furthermore, they suggested that interventions to increase assume a dynamic reality, a state of flux which emotional and social support to women victims can be captured via prolonged engagements with of violence might reduce the negative subjects. These methods are the only means of consequences to mental and physical health. understanding certain psychological phenomena, Battered women who receive emotional and such as, motivations, beliefs, decision processes tangible support may be less susceptible to the and also they allow participants reflections on, deleterious psychological impact of their partner’s and understanding of, social phenomena. abuse (Cohen and Wills, 1985; Flannery, 1990; Therefore for the purpose of the study Kumar et al., 2005). Further it was also found that biographical methods were used. Narratives women’s perceptions of social support also were obtained from the women which allowed directly affect their mental health by moderating them to speak for themselves and reconstruct their sense of psychological well-being (Arias et their experiences in the light of how they felt about al., 1997) or by mediating the relationship between them. These narratives were obtained through abuse and mental health (Thompson et al., 2000). in-depth individual interviews. The current study was carried out to The sample for the current study was selected understand the reasons for staying in marriage/ from the De-addiction Centre at NIMHANS and partnership regardless of husband’s drinking and Abhaya Hospital, Bangalore. Wives of persons violence, coping strategies, social support, with alcohol dependence (PAD) currently living expectation from heath agency, and future plans with their husbands were included in the sample. among wives of persons with alcohol Wives of persons with dependence on other dependence. drugs (except tobacco) and co-morbid psychiatric diagnosis were excluded. Wives who themselves Method used alcohol were also excluded. Initially the women were screened for violence using the

39 Nayar et al./ Narratives of wives

Abuse Assessment Screen by McFarlane et al. session notes. Interviews were transcribed from (1992). The researchers prepared a semi- field notes to understand processes, links and structured interview guide keeping in view of various themes. They were fed into the computer research aim as well as review of literature. The and read for identification of themes and patterns. semi- structured interview guide was During the initial stage coding was carried out subsequently validated by experts working in the by reading and rereading every line of the text field of domestic violence and substance abuse. in the search for meaning units. Coded material Twelve women in the age range from 25 to 54 was retrieved in the form of quotes. Memoing years were interviewed. Four each were post which involves writing reflexive commentaries on graduates, graduates and below pre-university some aspect of the data, theory or method as a college. Six of them were employed and six were method for deeper analysis was also used to unemployed. Seven out of the twelve women expand on the codes and explain them in detail. were from a high socio-economic background, four from middle socioeconomic and only one Results from a lower socioeconomic background. In terms of profile of husband, three of the husbands were The women who took part in the interviews postgraduates, five were graduates and four were expressed their feelings, experiences, reasons for below pre-university college. Five of the staying in violent marital relationships despite husbands were currently employed whereas abuse by their husbands. The major themes seven were unemployed. reported below include quotes taken directly from The process of data analysis was carried out the interviews. These are presented in the by using the grounded theory approach. This participant’s own words. approach was considered important because its central focus is on inductively generating novel Reasons for Staying on Despite Violence theoretical ideas or hypotheses as opposed to testing theories specified beforehand. In so far All the women interviewed had experienced as these new theories ‘arise’ out of data and are multiple stressors due to their husband’s drinking supported by the data, they are said to be as well as abusive behavior. The personal, familial grounded. It is only at a later stage of analysis and socio-economic factors made these women that these new ideas are related to existing theory. stay in the marital dyad despite continued Coding process was data- driven, wherein at the violence towards them as well as towards their initial stage coding was carried out by reading children. These factors have been explained the narratives and trying to figure out what was under the following themes - relationship with happening - an approach taken by the advocates husband, children’s well-being, condition of natal of grounded theory (Glasser and Strauss, 1967). family and societal response. The women offered Coding was carried out on computer using a multiple reasons for staying on and their scientific software ATLAS.ti (Version WIN 4.2). responses were not limited to the above This is a powerful workbench for qualitative mentioned themes. A combination of these analysis of large bodies of textual, graphical and factors made them stay on. audio data. It offers a variety of tools for Majority of the women appreciated the accomplishing tasks associated with any positive aspects of their husband’s when they systemic approaches to “soft” data e.g. material were not drinking. Six of the women described which cannot be analyzed by formal statistical that they had a good relationship with their approaches in meaningful ways. The qualitative husbands when they were not drinking. Apart data in this research consisted of interviews and from this, they were appreciative of husbands

40 Nayar et al./ Narratives of wives for helping their natal family and this made them asked me come back to them. But I thought that stay on in the marital relationship. my going back will bring dishonor to the family Six of the women spoke about the need to so how could I go back?”. protect the rights of their children and provide them with all the facilities so that their children Coping Strategies are not deprived. One of the women said that there were times that she had threatened to leave In living with husbands who were alcohol but was helpless as she did not know where to dependent, there was no one way to manage go and how to care for her children. The main difficulties. The women faced obstacles at every theme that came out in the narratives was the step they took and had to keep re-inventing the shift of focus from themselves to the children. strategies that they applied to manage Another factor which made women stay on themselves. Three of the women, having little in oppressive relationships was the condition of time for themselves spoke about crying in an their natal families. Many of the women isolated place and feeling better afterwards. One mentioned presence of unmarried siblings whose woman spoke about screaming at her husband in future might be affected in case of their return. frustration and refusing to carry out activities at Marriage by choice also prevented them from home like cooking. Fighting with parents as they going back to their natal families. had arranged the marriage describes a way of The response of the larger social network, coping in which an effort is made by the woman cultural beliefs about marriage and woman’s to shift the locus of control from herself to position also influenced the decision not to leave someone else. Since most efforts did not work, the abusive relationship. The women spoke the women said that they distanced themselves about growing up with certain beliefs that from their surroundings by engaging in other ‘women should always stay with their husbands’ activities. Withholding emotions and not and therefore moving away could not be expressing sadness to others were the few other considered. Many revealed that although their strategies used commonly by almost all the parents asked them to come back, they chose to women. stay on as their going back would have brought Another way in which they coped was by dishonour to the family. relying on other people and prayers. In this “I stay with him because he was nice and theme, women described people as well as prayers now also if he is not drinking he is nice although as being a major source of strength for them. that is less and less.” Source of support include children, their natal “Sometimes I think of leaving but I stay on family and workplace. Five of the respondents because a wife’s place is with her husband. When said that their children were their main source of he is not drinking he is nice to me and promises comfort and hope. Another woman outlined that to change. Usually he is a nice man and a God whenever she sat alone; her younger son comes fearing person…”. and hugs her which makes her feel much better. “I never thought of leaving although Others said that looking after their children was sometimes I threatened to do so. But where can their main source of coping. Two of the women I go and what would happen to my children. I spoke about talking to their natal family members have to adjust - what else can I do?” . when things became too stressful was useful. “Where will I go taking my children, my father One woman described her employer as being is not there and brothers are studying and sister supportive and listening to her problems. Seven needs to be married”. described praying as the one major way of coping “After a few months I told my parents who and deriving strength.

41 Nayar et al./ Narratives of wives

A major theme that came out in the narrativeswant people to pity me. Why should I disturb was how being employed somehow helped the others?, I can manage on my own”. women to cope. Two of the women clearly stated “I feel that this is my fate and I have to live that in their work place, they were able to block with it, I manage by praying. Every morning out the difficulties that they were having at home, after getting up I pray, I do the same during the talk about different things with their friends and night and it helps me to get over difficulties.” involve themselves in their work. One of the “Sometimes I feel like a volcano out of which all women expressed apprehensions about coming the lava will come out one day but then I feel back home everyday as she was unsure what that others might be worse, there are people was going to happen and what her husband was who are blind, deaf….. I am much better; I am going to do. Workplace was viewed as a place always optimistic and feel that there is still where they recharged themselves to get ready hope.” for what would happen in the evening. Going for work is linked to another theme of Response of Social Network refocusing on other things besides the husband’s drinking. In this theme three of the women spoke This has been presented separately as it about engaging with household work, with was felt that there was a need to bring out the children so that they had no time to think about details of this theme among the responses. These their problems. A few women described focusing included the people around them, the kind of help on the positive aspects in their life. they offered to the respondents and the reasons Further refocusing on the their privileges as for which the respondents failed to utilize the compared to others who are also deprived, for help and support which was available to them. example, reflecting on people with disabilities also This area has been discussed under the two helped them to feel that life had given some themes of quality of help available and accessing positives and they had to work on them. These support. As the focus of this research is to look thoughts usually had the power to revitalize them at the strengths, positive support available has and help to cope in difficult circumstances. been presented first, after which the negative In continuation of the theme of refocusing reactions have been presented, although this and rebuilding their lives, the patterns emerging might not be the defined pattern in the actual in the narratives shown that the women decided lives of women. to make a choice of doing things differently. This Many of the women spoke about their natal is evidenced by different changes they make to family members helping them out by listening to their lives – starting work, celebration of rituals/ them, offering them financial help and so on. festival, going out with other women for lunch However, one of the main themes that came out and so on. “I tell myself that I can survive this was the reluctance to access support from their and eventually things will become better. After natal families. Nine of the women said they had crying I feel that I can take care of things”. stopped availing help because of multiple “The main reason for my happiness is my reasons. The reasons included the husband’s children who are doing very well in their school abusive behavior whenever the woman’s parents and are very well behaved. They always help came home. The respondents also spoke about me out in the house also; I feel someday there hesitating to burden their natal families further will be a change”.“There are times when people as they had their own financial and health ask me how I can continue to laugh and work, concerns. They also felt that talking about their that I should show more distress. But I do not husbands in a negative manner was demeaning feel like crying in front of anyone as I do not to themselves. Therefore they preferred to keep

42 Nayar et al./ Narratives of wives quiet in most situations, often leading to a sense Many women expressed the need to have a of isolation. happy family life which they had been unable to Five of the women spoke about being get. Even if drinking of the husband did not blamed by their in-laws for their husband’s stop, most of the women planned to focus on the drinking. Two of the women reported that their future of their children in order to make their life husband’s family members never made any efforts secure. One woman had no plans for the future to stop his drinking, rather they blamed the and blamed it her own fate. Two of the women respondents. They also spoke about having to spoke about wanting to work as that would make listen to comments about their inability to manage them more secure and independent in future. their husbands as compared to other women who “I just want the hospital to make him stop could, which pushed them further into depression. drinking as things will change as soon as he They spoke about reluctance to call others for stops drinking.” help because of these comments and the feeling “Right now also I am not sure what will of being embarrassed by the husband’s behavior happen after going out but I have planned for and revealing sordid details of their family life. my future so that I can at least make things secure “I cannot ask my family for help as they are for me and my children.” very poor. My father has been dead for some “I feel – why am I not independent, if I was time and so they cannot really help. I do not working then I would not have to be dependent like to talk to either his family or mine because on his money at all. Tomorrow if he does business I feel that they will think that how can I talk and loses everything I cannot do anything but if about my husband like that, also I feel that it it was my money, I could save. So why can’t I will be insulting to talk to his family or mine.” earn?”.

Expectations from the Health Set Up Discussion

This code describes the processes by This study was carried out to explore the which women reach the health set up with their reasons why wives of persons with alcohol husbands. It entails many struggles that they dependent persons (PAD) continue to stay in have faced. This area has been discussed under the marital dyad despite violence, as well as to the themes of – ‘approaching a health set up’, understand their coping strategies, existing and ‘help needed’ and ‘vision of the future’. accessible social support system, expectation of In this theme initially the women spoke about services from health agency, and their future the difficulties that they faced in bringing their plans. One of the main reasons for staying with husbands to the health set up. Some expressed an abusive and violent partner is the presence of financial difficulties, reluctance of husband to a good relationship with him when he is not come for treatment and subsequent violence by drinking. These findings are in keeping with the husband after being forced to get treatment. In perspectives that view the battered woman as an terms of the help expected from health agency six individual who exercises a choice while making of them stated that they wanted their husbands constant decisions regarding her life in the violent drinking to be stopped. Other kinds of help relationship (Kirkwood, 1993). required includes information about ways in Apart from this, the women gave multiple which to help the husbands to remain abstinent, reasons for staying on, which included concern counseling to improve the quality of marital for the welfare of children or limitations of their relationship and inputs about changing the home natal families, their ability to take alternative jobs environment. to supplement family income and cope with the

43 Nayar et al./ Narratives of wives positive aspect of work environment made them sense of identity helps us to comprehend better to stay on in abusive relationship. They had also why many women, in spite of their economic carefully thought about what would be the independence, choose to suffer humiliation rather response of the larger society and how they than leave an oppressive husband. would cope with it. Their staying on in the Moreover, women’s faith in marriage as an relationship could not be simplistically institution is still strong and majority of the understood as a ‘traumatic attachment’, rather it women in the current study were still committed needs to be seen as a rational decision that they to preserve their marriage despite the odds. This have made after considering all options in their finding directly implies the kind of socio-cultural living circumstances. The alternative framework acceptance and tolerance of violence. Beliefs also views battered women’s staying as the result about the value of relationships coupled with of rational decision-making process evaluating emotions such as hope (Thompson, 1989) and the perceived costs and benefits within the loneliness propel many abused women into context of a multidimensional relationship (Pfouts, staying on despite violence (Johnson et al., 1992). 1978). Such intimate relationships are Further, current findings revealed that the conceptualized in terms of duality and contrasts, absence of family support, presence of children as simultaneously a source of love and danger and social stigma attached to separation from (Lempert, 1996). Such a view also acknowledges the husband also influenced women’s decision the positive feelings that women may have about making process. their partners and the relationship, as well as the Coping is a shifting, not static, process in desire to maintain the children’s relationship with that the individuals employ varying strategies their father (Dobash & Dobash, 1979). Few of according to the nature of the stressors, appraisal the women attributed drinking as the only of the available coping resources and other problem otherwise their husband was a good situational factors (Folkman and Lazarus, 1980). person. The attribution made by these women In the current study women employed a indicates their efforts to look at the positive sides combination of various coping strategies to deal of the relationship although they recognize the with an abusive relationship which included gradual deterioration in their marital relationships. emotional responding, distraction, distancing The focusing on the positives aspect of the oneself, self-blaming, talking to others, prayers, relationship came through and strongly. This focusing, and going for work. James and phenomenon can be understood if we look at the Goldman (1971) found that the wives of alcoholics analysis given by Kakar (1989) where he explored tend to report presence of all types of coping Indian sexuality through a psychoanalytic lens. behavior depending on the intensity and According to him the cultural image comes frequency of alcoholismic episodes. When such through sharply in a woman’s yearning for the coping mechanisms fail, low frustration tolerance couple or jodi. He states that the jodi (couple) is might later lead to suicidal behavior. In the current a “cultural self object” which connects the woman study a few participants expressed suicide as the to a community of Indian women and thus helps lost resort if nothing works out whereas two of to maintain the vitality and continuity of her the women took constructive steps to join for identity. It is the contribution of this ideal to job and make themselves self-reliant. Lempert maintain a sense of the self which helps us to (1996) found that the battered women sought help understand the tenacity with which women from only when they regarded their own resources all strata of Indian society cling to the notion of and alternatives as depleted. In the current study the indissolubility of the couple. The persistence when the difficulties increased the women made and the importance of the jodi for the woman’s efforts to access help from a health set up. The

44 Nayar et al./ Narratives of wives main theme that appeared was the reluctance to and helpmate, the weaver of those relationships access this support due to the feeling of social on which she in turn relies. But while women embarrassment. The present finding was similar have thus taken care of men, men have in their to the study by Fleury et al. (1998) in which theories of psychological development as well abused women did not seek help due to shame, as in their economic arrangements, tended to social embarrassment, and fear of physical safety assume or devalue that care. Maturity has been for themselves as well as their children. equated with personal autonomy and concern Achieving economic independence for battered with relationships as women’s weakness rather women often plays a decisive role in their freedom than as a human strength (Miller, 1976). Women’s from victimization. In the current study, majority empowerment needs shift from self-blame to of the women wanted to secure job in order to realistic evaluation of personal resources to gain independence in future. Wilson et al., (1989) become economically independent to fight concluded that working away from home appears against violence. to be a crucial survival strategy, possibly because it lessens the battered woman’s economic, social References and emotional dependence on her husband. Holding a job diminishes a battered woman’s Arias, I., Lyon, C.M., & Street, A.E. (1997). Individual isolation thus giving her a different perspective and martial consequences of victimization: of her world (Gelles, 1976). Moderating effects of relationship efficacy and spouse support. Journal of Family Violence, 12, Conclusion 193-210. Barnett, O.W., Martinez, T.A., & Keyson, M. (1996). The relationship between violence, social The responses given by women indicate that support, and self-blame in battered women. they adapt to their circumstances, because for Journal of Interpersonal Violence, 11, 221-233. them to leave a relationship is not a matte of just Cohen, S., & Wills, T.A. (1985). Stress, social support leaving or staying, it involves looking at things and the buffering hypothesis. Psychological from a wider perspective, understanding the Bulletin, 98, 310-357. repercussions of their behavior on them. Even Coker, A.L., Davis, K.E., Arias, I., Desai, S., Oltmans, in term of planning for future, many concentrated E., Brandt, H.M., & Smith, P.H. (2002). on their children. This is because women define Physical and mental health effects of intimate partner violence for men and women. American themselves in the context of human relationships Journal of Preventive Medicine, 33, 4, 260-268. and also judge themselves in terms of their ability Dobash, R. E., & Dobash, R. (1979). Violence against to care. The results of this study highlight the wives: A case against the patriarchy. In R.E. strengths of women living in an oppressive Dobash, R.E. & E. Dobash (Eds.), Violence violent relationship. Despite the hardships and against women ( pp1-13). New York: The Free uncertain future, the women interviewed seem to Press. have found a meaning in their lives and were in Dunham, K., & Senn, C.Y. (2000). Minimizing negative the process of rebuilding through evaluation of experiences: Women’s disclosure of partner Journal of Interpersonal Violence the resources available to them. This was abuse. , 15(3), 251-261. appropriately summed up by one of the woman Finn, J. (1985). The stress and coping behavior of as follows “I can spend my life crying or I can battered women. Social Casework: The Journal do something about it – be a role model for my of Contemporary Social Work, 66, 341-349. child.” Fleury, R.E., Sullivan, C.M., Bybee, B.I., & Davidson, Gilligan (1982) stated that a woman’s place in W.S. (1998). Why don’t they just call the cops?: a man’s life cycle has been of nurturer, caretaker Reasons for differential police contact among

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women with abusive partners. Violence and women. Qualitative Sociology, 20, 2, 289-309. Victims, 13, 4, 333-346. McFarlane, J., Parker, B., Soeken, K., & Bullock, L. Flannery, R.B. (1990). Social support and (1992). Assessing for abuse during pregnancy: psychological trauma: A methodological review. Frequency and extent of injuries and associated Journal of Traumatic Stress, 3, 4, 593-611. entry into prenatal care. Journal of the American Folkman, S., & Lazarus, R. S. (1980). An analysis of Medical Association, 267, 23, 3176-3179. coping in a middle-aged community sample. Miller, J.B. (1976). Toward a new psychology of Journal of Health and Social Behavior, 21, 219- women. Boston: Beacon Press. 239. Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990). Gelles, R.J. (1976). Abused wives: Why do they stay?. Alcoholism treatment: Context, process, and Journal of Marriage and the Family, 38, 659- outcome. New York: Oxford University Press. 668. Orford, J. (1990). Alcohol and the family: An Gilligan, C.(1982). A Different Voice. London: Harvard international review of literature with University Press. implications for research and practice. In K.L. Glaser, B.G and Strauss, A. L. (1967). The Discovery Kozlowski, H. Annis, H.D. Cappell, F. Glaser, of Grounded Theory: Strategies for Qualitative M. Goo, Y. Israel, H. Kalant, S.M. Sellers & J. Research. Chicago:Aldine. Vinglis (Ed), Research Advances in Alcohol Halford, W.K., Price, J., Kelly, A.B., Bouma, R., & and Drug Problems (pp 81-153). New York: Young, R.M. (2001). Helping the female partners Plenum Press. of men abusing alcohol: A comparison of three Pfouts, J.H. (1978). Violent families: Coping responses treatments. Addiction, 96, 1497-1508. of abused wives. Child Welfare, 57, 101-111. James, J.E., & Goldman, M. (1971). Behavior trends Shotter, J (1993). Conversational Realities. London: of wives of alcoholics. Quarterly Journal of Sage Publications. Studies on Alcoholism, 32, 2, 373-381. Thompson, C. (1989). Breaking through walls of Johnson, I.M., Crowley, J., & Sigler, R.T. (1992). isolation: A Model for churches in helping victims Agency response to domestic violence: Services of if violence. Pastoral Psychology, 38, 35-38. provided by women. In E.C. Viano (Ed), Thompson, M.P., Kaslow, N.J., Kingree, J.B., Rashid, Intimate violence: An interdisciplinary A., Puett, R., Jacobs, D., & Matthews, A. perspective (pp191-202). Vristol: Taylor and (2000). Partner violence, Social support and Francis. distress among inner city African American Kakar, S. (1989). Intimate relations- Exploring Indian women. American Journal of Community sexuality. New Delhi: Penguin Books. Psychology, 28, 127-143. Kemp, A., Rawlings, E.I., & Green, B.L. (1991). Post United Nations. (1993). Family enrichment: Programs traumatic stress disorder (PSTD) in battered to foster healthy family development, Series women: A shelter sample. Journal of Traumatic No. 8, Geneva. Stress, 4, 1, 137-148. Wilson, M.N., Baglioni, A.J., & Downing, D. (1989). Kirkwood, C. (1993). Leaving abusive partners. Analyzing factors influencing readmission to a London: Sage Publication. battered women’s shelter. Journal of Family Kumar, S., Jeyaselan, L., Suresh, S., & Ahuja, R. Violence, 4, 275-284. (2005). Domestic violence and its mental health Yoshihama, M. (2002).Battered women’s coping correlate in Indian women. The British Journal strategies and psychological distress: Differences of Psychiatry, 187, 62-67. by immigration status. American Journal of Lempert, L.B. (1996). The other side of help: Negative Community Psychology, 30, 3, 429-450. effects in the help-seeking process of abused

46 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 47-60 Clinical Psychologists (ISSN 0303-2582)

Media-portrayed Idealized Images, Body Dissatisfaction and Negative Affect in College Women

1Kanika Aggarwal Khandelwal

Past research has highlighted the role of media for portraying thinning standards of beauty and causing body dissatisfaction among young women. The present research experimentally investigates the effect of the thin ideal, as portrayed in the media, on body dissatisfaction and negative affect in females. 96 undergraduate female students were randomly assigned to two groups that were shown and asked to rate the attractiveness of thin idealized images of women (experimental group) or pens (control group). After viewing the images, participants were required to complete the Adapted Satisfaction and Dissatisfaction with Body Parts Scale (Stice, Maxfield & Wells, 2003) and PANAS-X (Watson & Clark, 1991). Participants were briefly interviewed about their conceptions of beauty. Age, BMI and the number of stimulus presentations were matched. Results showed no significant differences between the two groups, as assessed by t-tests, in body dissatisfaction and negative affect (or any of its sub dimensions, fear, hostility, guilt or sadness). Content analysis of interview responses revealed that participants described a beautiful woman as having “inner beauty/mind” than “being slender”. Contrary to popular research, it may be concluded that not all young women are affected by media exposure. Body dissatisfaction and preference for thinness are affected by socio-cultural and personal factors.

Keywords: Body dissatisfaction; Negative Affect; Media Exposure; Thin Ideal

Concern with physical appearance has television, etc. are all forms of the media that haunted womankind since the beginning of portray unrealistic standards of female beauty. recorded history, perhaps even before Cleopatra. One survey (Goodman, 1995) showed 11 After all, physical appearance is very influential mainstream magazines like Vogue to have 645 in social relations and psychological functioning pictures of thin women as opposed to only 11 of (Jackson, Hunter, & Hodge, 1995). We also believe heavy women. Newspapers ads showed 288 in the ‘what is beautiful is good’ stereotype: the pictures of individual thin women as compared to good fairy/princess is always beautiful; the wicked 12 heavy women (and they all featured for large stepmother is always ugly. But first, who decides size clothing). 160 commercials showed 120 ads what is beautiful? “Beauty lies in the eye of the featuring thin women exclusively as compared to beholder”, goes a common saying, but do we know 12 heavy women. To top it, an average person who the beholder really is. watches 35,000 commercials in a year. As regards Every day, we are bombarded by thousands television, Westerners are estimated to watch, on of images of slim and beautiful women. an average, 2.07 hrs (Rivadeneyra &Ward, 2005) Commercials, billboards, women’s magazines, to 7 hrs in a day (Tiggemann, 2002). Young college films, appearance music videos, mainstream goers in India watch about 2 hrs 36 minutes of

1Department of Psychology, Lady Shri Ram College for Women, University of Delhi, Lajpat Nagar IV, New Delhi-110024, Correspondence: 15A/16, Upper Ground Floor, East Patel Nagar, New Delhi-110008 Correspondence: email: [email protected] *This paper was presented at the European Congress of Psychology in Oslo, Norway, 7-11 July 2009. Khandelwal/ Potrayal of women television per day (Pareek & Khandelwal, 2008). women exposed to sexist ads judged their current Constant exposure to media means that we body sizes as larger and revealed a larger see media-portrayed ideals of attractiveness all discrepancy between their actual size and ideal the time, making exceptional good looks seem real, body sizes, than women exposed to non-sexist normal and attainable. Further, “the women in advertisements or to no advertisements. media are not only overwhelmingly small, but also Appearance anxiety has also been reported to smiling, self-satisfying, exciting, dynamic, increase after viewing advertisements featuring romantically involved, and generally having a idealized images (Monro & Huon, 2005). Pictures splendid time” (Goodman, 1995, p. 49). of female models in magazines have indeed been Fouts and Burggaff (2000) found that thinner found to exert a powerful influence on a woman’s female characters in television situation comedies feelings about her own body, regardless of her received more compliments from men than did own weight and size (Hamilton, Mintz, & heavier characters. Kashubeck-West, 2007). According to Groesz, These models are often the only role models Levine and Murnen (2002), mass media offered to young women, who may become promulgates a slender ideal that elicits body obsessed with a culturally imposed ideal that is dissatisfaction. In their meta-analysis of 25 unrealistic and unrealizable for the vast majority. studies, they found an overall d value of 0.31, Research has found media to contribute the indicating that body satisfaction decreased with strongest perceived pressure on body image by viewing of thin models as compared to average all individuals, regardless of age, to attain the ideal size models, plus size models, or inanimate objects. beauty (Green & Pritchard, 2003). Over the past The link between media exposure and its three decades in western culture, models have subsequent effects on body image is, however, become increasingly thin; promoting a modern not that clear. For instance, King, Touyz and ideal of feminine attractiveness, a thin body (Owen Charles (2000) found that women who were & Laurel-Seller, 2000). For instance, the average concerned about their body shape judged thin American woman is 5 ft 4 in and 140 lb, whereas celebrities as thinner than actuality, whereas the average model is 5 ft 11 in and 117 lb (National unconcerned women judged the celebrities more Eating Disorders Association, 2002). accurately. Others have found a decrease in body Past research has focused on the influence satisfaction among female undergraduates after of the media on women’s perception of their just a 15-minute exposure to fitness and health bodies. Persistent messages that one is not thin magazines, but only for those already dissatisfied enough result in dissatisfaction with one’s with their bodies (Cameron & Ferraro, 2004). Lavin physical appearance (Thompson et al., 1999) and and Cash (2001) found that media exposure did foster negative affect (Stice & Bearman, 2001). not alter the mood of women, but women who Frequent viewing of mainstream television is were schematically invested in their physical associated with decrease in body satisfaction appearance were especially susceptible to the across adolescence (Schooler, 2008). Identification negative effects of appearance-related (versus with television stars (for girls and boys), and control) information. It appears that having certain models (girls) or athletes (boys) positively assumptions or schemas about the importance correlates with body dissatisfaction (Hofschire and influence of one’s appearance potentiates a & Greenberg, 2002). Viewing appearance music negative impact of information about appearance videos featuring thin women leads to increased stereotyping. social comparison and body dissatisfaction Body dissatisfaction and a preference for (Tiggemann & Slater, 2003; Bell, Lawton, & thinness have been reported in various cultures Dittmar, 2007). Lavin and Cash (2001) found that and ethnic groups, for instance among Australians

48 Khandelwal / Idealized images, negative affect and body dissatisfaction and Italians (Durkin, Paxton, & Sorbello, 2007), neck, shoulders, and chest) among the Indian Israelis (Barak et al., 1994), Mexican Americans women, emerging as a distinct body image (Ayala et al., 2007), Asians (Croll et al., 2002), construct. In contrast to the Canadian women, Chinese (Chen, Gao, & Jackson, 2007) and the Indian women did not overestimate the Japanese (Yamamiya, Shroff, & Thompson, 2008), ‘fatness’ of their abdomen, hips, thighs, and legs. among others. The importance of appearance as Others (for e.g., Srinivasan et al., 1995; also what constitutes attractiveness is governed Srinivasan et al., 1998), on the other hand, suggest by socio-cultural standards. For instance, Black that norms for thinness are becoming more males have a greater preference for a larger body insistent in Indian culture. Shroff and Thompson size and a more positive image than whites (2004) studied the role of media and interpersonal (Ricciardelli, McCabe, Williams, & Thompson, influences on body image and eating disturbances 2007). Yates, Edman, & Aruguete (2004) found on female adolescents and adults in India. They that Filipino males desired a smaller body size, suggested that cross-culturally, similar potential while Japanese and Chinese males desired a larger risk factors (teasing history and internalization) body size. might explain the development of body A small number of studies have been dissatisfaction and drive for thinness. Ahmad et conducted on Asian females in the area of body al. (1994) found Muslim Indian males to have image. Davis and Yager (1992) have drawn the higher body dissatisfaction than Whites. Iqbal, attention of researchers to the paucity of research Shahnawaz, and Alam (2006) reported male college on issues relating to eating problems in non- and school students to have significantly greater Western cultures, especially in Asian countries. positive body image than females. Body image Few cross-cultural studies available in this area has been related to maladjustment (Menon & show mixed results: some of these have shown Pant, 2007) and depression (Iqbal, Shahnawaz, & more positive body attitudes among non-Western Alam, 2006) among Indian students. females (e.g. Akan & Grilo, 1995; Furnham & As India in the 21st century is fast developing, Alibhai, 1983), while there are some findings women are caught in a transitional situation. On contrary to this (e.g. Davis & Yager, 1992). The one hand, traditional sociocultural pressures awareness about body dissatisfaction in India is promote a larger body size; on the other, Western even more nascent. Some psychiatric literature pressures promote slimness. Research on body emphasizes a lack of body image concerns and image has primarily been conducted among fear of obesity in Indian patients (Khandelwal et Western women who highly value the thin ideal al., 1995). A study among young college-goers in body size. In traditional non-Western societies, a India (Pareek & Khandelwal, 2008) suggested that relatively fat body is regarded as a sign of health conventional beauty (good looks, being thin, fair and a symbol of prosperity (Dally & Gomez, 1979; complexion, etc.) was important only to traditional Lee, Hsu, & Wing, 1992). In societies subjected males and females, while nontraditional males and to periodic food shortages, thinness is often females emphasized confidence, attitude, voice associated with low socio-economic status. and sartorial styles in their favorite television Considering that body image attitudes may be characters. Gupta, Chaturvedi, Chandarana and unique in each culture (Jaeger et al, 2002), there is Johnson (2001) compared weight-related body a need to understand them in the Indian socio- image concerns among 18 to 24-year-old women cultural setting Will exposure to thin idealized in Canada and India. They found the nature of images result in increased body dissatisfaction the underlying body image construct to be on young college going women in India? Will it different between the two groups with concerns result in greater negative affect? Or do the young about the weight of the upper torso (i.e., face, strong-minded women of today reject current

49 Khandelwal/ Potrayal of women

Western standards of beauty? The present study confidential. In order to optimize deception, only was designed to answer these questions using students from non-psychology background were an experimental paradigm. selected.

Hypotheses Measures

1. There will be a significant difference in body Body Dissatisfaction dissatisfaction between experimental group and Satisfaction and Dissatisfaction with Body control group exposed to pictures of thin women Parts Scale, developed by Berscheid, Walster and models and neutral stimulus respectively. Bohrnstedt (1973), and adapted by Stice, Maxfield and Wells (2003) was used to assess body 2. There will be a significant difference in dissatisfaction. This scale asks participants to negative affect, and its sub dimensions: (a) fear, indicate their level of current satisfaction with nine (b) hostility, (c) guilt and (d) sadness, between body parts (weight, figure, body build, stomach, experimental group and control group exposed to waist, thighs, buttocks, hips and legs) on a 5- pictures of thin women models and neutral point scale ranging from extremely dissatisfied=1 stimulus respectively. to extremely satisfied=5. Items were summed for analyses, with high scores indicating greater Method satisfaction. The scale has acceptable internal consistency (α = 0.94), temporal reliability (3 week Experimental design test-retest r=0.90), and predictive validity (Stice, The experiment followed a between-subjects 2001), and has been previously used on female design, with participants randomly assigned to undergraduate students (Stice, Maxfield, &Wells, either the experimental condition, exposed to 2003). images of ten thin, idealized women or to the control condition, exposed to ten neutral Negative Affect inanimate images (pens). Participants in both The fear, hostility, guilt and sadness conditions were asked to rate each image’s subscales from PANAS-X were used to assess attractiveness. The independent variable was the negative affect (Watson & Clark, 1991a). type of image shown, and the dependent variables Participants reported the extent to which they were were body dissatisfaction and negative affect (and currently feeling 23 negative emotional states its sub dimensions fear, hostility, guilt and (e.g., sad, ashamed, angry, nervous, etc.) on a 5- sadness). Age, BMI, number of stimulus point scale ranging from very slightly or not at presentations and exposure time of each image all=1 to extremely=5. Items were summed to form were matched. an overall negative affect composite, with high scores indicating greater negative affect. Sub Participants scores on Fear (6), Hostility (6), Guilt (6) and Participants were 96 female undergraduate Sadness (5) were also obtained after adding students from a college located in New Delhi, responses dimension-wise. PANAS-X has been India. Their age ranged between 18-21 years shown to have acceptable internal consistency (Mode = 20). They came from relatively upper (M α = 0.87), temporal reliability (2-month test- middle class socio-economic backgrounds. The retest r= 0.71), and convergent validity (Watson marital status of all participants was single. & Clark, 1991a). Furthermore, self-reported Students were told their participation was negative affect on the PANAS-X shows voluntary and that their responses would be kept

50 Khandelwal / Idealized images, negative affect and body dissatisfaction agreement with peer reports (Watson & Clark, were moderate on attractiveness and hence 1991b). considered neutral.

Idealized Images Weight and Height Scale Media images have been used in previous A professional medical scale was used to studies with success (for e.g., Irving, 1990; measure weight (in kilograms) and height (in Posovac, Posovac, & Posovac, 1998; DeBraganza inches), which were used to calculate BMI (body and Hausenblas, In Press). The images of thin mass index). attractive models used for this study were taken from websites that contained images of models, Procedure for e.g. http://www.realbollywood.com. Some Each participant completed the experimental images were also taken from popular women’s protocol on an individual basis. 100 participants fashion magazines such as Femina and Elle India. were randomly assigned equally to either the Initially 30 images of attractive women that experimental or the control condition. The study encompassed the thin ideal were taken. 20 was described to them as an investigation of psychology students were asked to rate them on attractiveness to understand perceptions of attractiveness on a 5 point Likert scale, ranging college students, to keep them blinded about the from not very attractive=1 to extremely true nature of the experiment. Informed consent attractive=5. Images that were not rated at least 4 was obtained from each participant. Rapport was by 75% of the students were discarded. From the formed with each participant by carrying out a remaining, 10 images found to be the highest on brief informal conversation. Demographic attractiveness were selected for presentation in information about their age, socioeconomic status the experimental condition. All models appeared was also taken. Their fluency in English was to be in the age group of the participants, and a ascertained. sampling of culturally diverse individuals (in terms The participant was then seated in front of a of appearance) was chosen. Care was taken so as computer monitor, and exposed to either images to not include any known model as it might have of thin models (experimental group) or pens evoked other reactions (stemming from her (control group). Presentation of images was done personality, life style, etc.) from the participants. by means of a PowerPoint program on the computer, each image exposed for 7 seconds each. Neutral images The order of presentation of the ten images in each condition was decided by a random draw of Past body image research has used control lots. Instructions were read out from the computer images of normal weight models, obese models, informing the participant that she would see 10 or inanimate objects like cars, pens, and houses images, each one shown only for a brief period of (Groesz et al., 2002), fashion accessories (Durkin time. She was asked to rate each image on & Paxton, 2002), and perfume bottles (Joshi, attractiveness on a 5 point Likert scale, ranging Herman & Polivy, 2004). This study used images from not very attractive=1 to extremely of pens as control images, as pens have no attractive=5, on a form provided. This was done obvious relation to eating, grooming or body to ensure that the participants were focusing on weight. Images were taken from various websites, the images at hand. for e.g., images.google.com (pens). 30 images of After the slide show, the participant was asked to pens were shown to 20 psychology students, who complete PANAS-X (negative affect subscales) were asked to rate them on attractiveness. From followed by Adapted Satisfaction and these ratings, images of 10 pens were chosen that

51 Khandelwal/ Potrayal of women

Dissatisfaction with Body Parts Scale. Each Preliminary analyses confirmed that there participant was then briefly interviewed about her were no obvious differences between the conceptions of beauty by asking, “In your opinion participants in the experimental and control what constitutes beauty in a woman?” Upon conditions in terms of height, weight, age and completion, each participant was asked to guess BMI. To ensure that the two groups were the purpose of the experiment, to assess whether equivalent on BMI, t-test for independent the manipulations were adequately concealed. Her samples was conducted to compare mean BMI of height and weight was then measured to calculate both the groups. A non-insignificant difference her BMI. Lastly, the participant was debriefed between experimental and control group on BMI and asked not to tell anyone about her experience. (t(94)=0.76, p=0.45) suggests that randomization The participantwas then thanked for her succeeded in creating equivalent groups (Table cooperation. 1). In order to test the significance of difference between the means of experimental and control Results group in the dependent variables of body dissatisfaction and negative affect (and its sub dimensions fear, hostility, guilt and sadness), t- Manipulation check indicated that two tests for independent samples were carried out participants from the experimental condition (Table 1). correctly guessed the aim of the experiment and Contrary to expectations, a non-significant hence their data along with two others from the difference between the two conditions in body control condition (selected randomly) was dissatisfaction was found (t(94)=0.84, p=0.40), dropped, which resulted in a final sample size of rejecting the first hypothesis that there will be a 96 (instead of the original 100).

Table 1. Comparison of Experimental and Control group on Body Dissatisfaction, Negative Affect (and its sub dimensions) and BMI

Dimensions Experimental Group Control Group tdfp

Body Dissatisfaction 26.98 25.48 0.84 94 0.40 (7.99) (8.72) Negative Affect (Total) 31.45 31.43 0.01 94 0.99 (12.11) (10.81) Fear 7.86 8.07 0.30 94 0.38 (3.47) (3.01) Hostility 8.32 7.82 0.77 94 0.48 (3.42) (3.21) Guilt 8.25 8.11 0.20 94 0.85 (3.48) (3.09) Sadness 7.02 7.43 0.51 94 0.60 (3.45) (3.90) BMI 22.18 21.67 0.76 94 0.45 (3.29) (3.03)

Note. All t values are statistically insignificant (p<0.05 ).

52 Khandelwal / Idealized images, negative affect and body dissatisfaction significant difference in body dissatisfaction (51.04%) over “facial and physical beauty between experimental group and control group (39.58%). Typical responses were “peace with exposed to pictures of thin women models and oneself”, “true beauty comes from within”, “a pens respectively. A non-significant difference in person beautiful from within reflects on her face negative affect between experimental and control and body” and that “physical beauty is superficial group is also obtained (t(94)=0.01, p=0.99). The and temporary”. In contrast, about 39% second hypothesis that there will be a significant emphasized “having a perfect body/figure”, “tall”, difference on negative affect between experimental “fair”, “slim”, “slender”, “long legs”, “sharp group and control group exposed to pictures of features”. Other mentioned qualities were thin women models and pens respectively is also confident attitude/personality, i.e. “someone who disproved. Further, statistically non-significant carries herself with confidence”, “has a positive differences between experimental and control and magnetic personality”, “self-esteem”, stylish in terms of someone who “dresses well”, “dresses Table 2. What constitutes beauty in a woman (N=96)

Sl. Attributes in a No. Beautiful Woman Frequency Percentage*

1. Inner beauty/Mind 49 51.04

2. Facial and physical beauty 38 39.58

3. Confident attitude/Personality 32 33.33

4. Stylish 23 23.96

5. Sharp Brain/Intelligence 19 19.79

6. Skills 16 16.67

7. Caring for others 14 14.58

8. Seductive 09 9.37

9. Others 11 11.46

*Note: The percentages do not add up to 100 as participants reported more than one quality at a time groups were obtained for all the sub dimensions appropriately and looks good every time”, “carries of negative affect viz. fear, hostility, guilt and herself well”, sharp brain (“wit”, “humor”, sadness, as well. Thus, none of the sub “intelligence”), skills (“interpersonal”, “good hypotheses 2(a), 2 (b), 2(c), and 2(d) were communication”, etc.), caring for others supported. (“humane”, “nurturing”, “concern for others and In order to understand the participant’s not just her own looks”), and even seductive conceptions of attractiveness, their interview (“sexy”, “husky voice”, “attracts men”). One responses were content analyzed (Table 2). respondent summed it very articulately, “I don’t Rather surprisingly, participants described a think looks matter. Too much importance is given beautiful woman as having “inner beauty/mind”

53 Khandelwal/ Potrayal of women to the concept of looking ‘thin’ and ‘beautiful’. other research (Durkin and Paxton, 2002; Blowers All this is very short term, if one does not have et al., 2003; Keery, van den Berg, & Thompson, the personality and the brain to achieve what 2004; Knauss, Paxton, & Alsaker, 2007). Botta they want…For me, someone with a strong (1999) argues that increased body dissatisfaction personality and a sharp bent of mind is attractive. due to encountering thin-body images should be I don’t care if I am thin or fat.” Some other confined to only those who endorse the thin ideal. responses were “fragile”, “achievement”, “good Although internalization was not measured career” and even “broad-minded”. directly, by means of interviews, it may be inferred that the present sample does not internalize the Discussion thin ideal as depicted in the media. Internalization The aim of the study was to experimentally of the thin ideal implies acceptance of and assess the effect of the thin beauty ideal, as maintaining a rigid belief that being thin is portrayed in the media, on body dissatisfaction necessary to be attractive. In sharp contrast, the and negative affect. It was expected that past present participants described a beautiful woman research that showed exposure to images of as having “inner beauty/mind” than being slender slender, ideal beauty has an adverse influence on (Table 2). For e.g., one participant said, “…true female body satisfaction and immediate affect, will beauty comes from within, it can’t be achieved be replicated. Contrary to expectations, the results by polishing just the upper layer of one’s flesh.” do not support any of the hypotheses framed for Further, it seems that the process of the study. These findings are contrary to previous appearance comparison also did not occur. Some research that has found women, following participant expressed “repulsion”, and even immediate exposure to thin models, to report “pity” after watching slender models as “(they) greater depression (Stice & Shaw, 1994; Pinhas et starve themselves to death”. Some said, “I can al., 1999), stress and shame (Stice & Shaw, 1994), never be like them, nor do I want to”, “I would anger (Pinhas et al., 1999), mood (Birkeland et al., hate to be a model”. One clearly said, “These 2005), weight concern (Posavac, Posavac, & models have different priorities and an extremely Posavac, 1998) and body and weight different lifestyle. I am happy the way I am and I dissatisfaction (Irving, 1990; Stice & Shaw, 1994; don’t relate or compare myself with them”. The Turner et al., 1997; Tucci & Peters, 2008). number of social comparisons women make after These results may be explained with the help exposure to ideal images partially mediates the of the dual pathway model (Stice & Agras, 1998) images’ effects on body dissatisfaction and and the Tripartite Influence model (Thompson et negative mood (Tiggemann & McGill, 2004). Some al., 1999). The former posits that perceived studies (for e.g. Cattarin, Williams, Thomas, & pressure from family, peers and media to be thin Thompson, 2000) have indeed demonstrated that leads to an internalization of the thin ideal, which only women with high scores on a measure of in turn leads to body dissatisfaction. In addition, internalization of the thin ideal who compared body dissatisfaction fosters dietary restraint and themselves with a representation of the thin, negative affect. The Tripartite Influence model attractive ideal (i.e., a “superior” target) proposes that three formative influences (peer, experienced a significant increase in body parents, and media) affect body image and eating dissatisfaction. This implies that viewing thin problems through two mediational mechanisms: media images would adversely affect body internalization of the thin-ideal and appearance dissatisfaction only when the individual carries comparison processes. Both models emphasize out an appearance comparison between herself the role of internalization of the thin ideal, as does and the media images, and when she internalizes the thin ideal standards of beauty, none of which

54 Khandelwal / Idealized images, negative affect and body dissatisfaction might have occurred in the present sample. looks. Discourses on gender equality, control of Another competing explanation for the the female body, diversity, individual autonomy, present findings may lie in participants’ objectification, patriarchy and sexism are experiencing media fatigue, as a result of being commonplace. This may have led to interrogation constantly bombarded with images of the thin of stereotypes of beauty and deconstructing ideal through magazines, television and movies. notions of an “ideal woman”. It has been estimated that young women now see Research does suggest the contribution of more images of outstandingly beautiful women in certain moderating factors in the relationship one day than their mothers saw throughout their between exposure to thin idealized images and entire adolescence. Just as prolonged viewing of body dissatisfaction, like identification violence in media desensitizes us to cruelty (Henderson-King & Henderson-King, 1997), (Sargent et al., 2002), it is possible that constant having a boyfriend (Lin & Kulik, 2002), age exposure to thin images may have desensitized (Groesz et al., 2002), schematic investment in one’s today’s women. In fact, post-manipulation physical appearance (Lavin & Cash, 2001), prior interviews indicated that many participants found body dissatisfaction (Posovac, Posovac, & media depictions superficial, unreasonable and Posovac, 1998; Durkin and Paxton, 2002), restricting the conception of beauty. For instance, restrained versus emotional eating (Joshi, Herman, one said, “I think beauty is not just about looking & Polivy, 2004), and drive for thinness (Pavelo, good as portrayed in the media. Media keeps 2006). In a focus group study on 16-year-old girls, trying to frame the thinking of people in a Tiggemann, Gardiner and Slater (2000) asserted conventional way and I do not think it is right”. that although the girls articulated a desire to be Interestingly, some even dismissed slimness of thinner, it did not necessarily mean they were models as “airbrushed” or “computer generated”. dissatisfied with their bodies, suggesting that their A possible interpretation of the obtained null meta-awareness and sophisticated understanding findings might also be located in the personal of the media and other pressures, serves to characteristics of the present sample. Personal moderate against these forces which would characteristics can either strengthen or diminish otherwise seem overwhelming. the relationship between media exposure and Lastly, body image concerns are influenced body dissatisfaction. For instance, Tiffanie (2003) by cultural and ethnic factors. The importance of did not find any significant difference on body appearance as also what constitutes image between those exposed to thin ideal images attractiveness is governed by sociocultural and those exposed to average images among a standards. Grogan (1999) asserts that body group of college psychology students. Wilcox dissatisfaction in women is normative in societies and Laird (2000) also believe that only women that prescribe a very narrow range of acceptable who ultimately value body shape compare body shapes. DeBraganza and Hausenblas (In themselves to thin media images and thus Press) did not find any change among African experience negative feelings about their own American women from pre- to posttest body bodies. The interviews have indicated that the dissatisfaction after viewing two sets of slides women in this study have rejected current (mass media ideals and controls). Asians are also standards of beauty, by emphasizing inner beauty reported to have lesser body dissatisfaction and over physical beauty. They have also underlined lower ratings for importance of physical the importance of “confidence”, “sharp brain” and appearance than Whites (Altabe, 1998). ‘intelligence” in a “beautiful woman”. While this In India, traditionally being thin has not been is speculative, it does seem that the present sample considered a positive attribute, rather unhealthy may be valuing achievement more than good and unattractive. In contrast, being plump was

55 Khandelwal/ Potrayal of women considered to be a sign of prosperity and perhaps have produced an effect as strong as say, even desirable as a symbol of feminine nurturance. watching a longer film or television with a thin The screen icons until about 10 years back were character, or reading a fashion magazine. Future rather curvy and voluptous, unlike the Western studies may explore the effects of various types screen icons, as have been statues of goddesses of media depictions on body dissatisfaction, in temples like Khajuraho. The attitudes towards perhaps using longitudinal designs. Lastly, body shape and weight prevailing in the West internalization of the thin ideal was not measured seem to be non-existent or uncommon in other directly, only inferred through interviews. cultures until such cultures begin to adopt the Examination of those specific aspects of the media values of Western cultures (Apter et al., 1994). In that may be influential in determining how women recent years, however women especially in internalize the thin ideal could be the focus of cosmopolitan cities like New Delhi, have sought future research. to replicate international beauty fashion trends Further studies may also attempt to explain on their own bodies, as broader cultural the cognitive processes of women who do not phenomena at large serve to reinforce newly experience weight concerns after viewing thin- imported ideas about beauty. As Runkle (2005) depicting media. Future research should search says, “The postliberalization actress is easily more broadly for individual attributes that identifiable: she is all too recognizable with her accentuate media effects. More cross-cultural long hair (poker straight), height (over 5’6"), tiny research is required to understand these waist (belly button exposed), and tight-fitting predisposing factors in varying cultural contexts. clothes - she is post-liberalization, post-modern India’s most ubiquitous icon” (p. 16). It is probable Conclusions and Implications that despite this, Indian women may not value Despite the limitations, the results are the thin ideal body size as highly as their Western promising. Media has often been lambasted for counterparts. portraying thinning standards of beauty and causing body dissatisfaction among young Limitations and Suggestions for Future Research women. It may be argued that mere exposure may It is important to consider the limitations of be insufficient to explain body dissatisfaction, this experiment when interpreting these rather women are likely to vary in terms of how unexpected findings. First, the use of fairly much they internalize societal ideals generated homogeneous, undergraduate females as research by the media. participants greatly limits the generalizability of It may thus be concluded that not all young the current findings to other populations. More women are equally affected by media exposure. research is certainly needed to understand if Individual vulnerability factors may render some Indian women do or do not value the thin ideal women more sensitive to the adverse effects of body size as much as their Western counterparts. media pressures to be thin and may be useful for Second, no pre-test was done to measure body identifying those at risk for eating disorders and dissatisfaction and negative affect to compare the other psychopathologies. An understanding of change in these measures. Third, the reliance on individual risk factors is critical to develop future self-report measures for the outcomes might not prevention and treatment programs. A psycho have been sufficiently sensitive to detect educational program to media literacy for experimental effects. Observational and vulnerable women could include learning how to physiological measures of affect may prove to be differentiate between real world expectations and more useful. Fourth, the presentation of ten ideal media representations, as well as teaching women thin body images for 7 seconds each may not to view their own bodies as sources of strength

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60 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 61-69 Hariharan et al./ Stress & Coping Styles of Clinical Pilots Psychologists (ISSN 0303-2582)

Stress & Coping Styles of Pilots in Indian Civil Aviation-An Exploratory Study

1 Meena Hariharan, 2 K.Shantha Nanda Prasad, 3 Sunayana Swain

Research in occupational stress has been revealing interesting facts for the past several decades. Occupational stress is a function of the nature of occupation and the occupational demands. One occupation that has unique occupational demands in terms of power position and risk is the profession of pilots. In addition to the normal sources of occupational stress the profession of pilot is unique in experiencing stress because of a typical physical environment and the human life risk involved. This attaches academic and human significance to the study on pilot stress. This is an exploratory study aimed at identifying stress levels and coping styles adopted by pilots employed by different airlines in India. Both the Occupational and Environmental Stress are measured by separate instruments. Coping styles of pilots is measured by projective technique. A sample of 122 pilots varying in experience and cadre from the domestic airlines in India were selected randomly. Relevant statistical tests were used to find out differences in stress levels and coping styles among pilots. The study revealed that, the pilots of senior cadre were found to experience higher levels of occupational than those in the lower cadre. Organizational affiliation of pilots was found to have impact on their stress. Most of the pilots adopted rigid style of coping. Pilots with low and high stress levels differed in their coping styles.

Keywords: Occupational tress, environmental stress, coping, aviation psychology

Stress is a condition or feeling experienced Health (Sauter et al., 1999) defined Work Stress as when a person perceives that demands exceed the harmful physical and emotional responses that the personal and social resources the individual occur when the requirements of the job do not is able to mobilize (Lazarus, 1991). The sources of match the capabilities, resources, or needs of the stress can be Physical (environment and worker. surroundings), Socio-cultural or psychological. Stress is studied in different occupational The individual’s occupation constitutes the major contexts. One such profession that interests every part of his/her environment. The physical one is the airline pilot. A pilot needs to spend environment, professional demands, social and long hours in a limited space but with a great deal organizational climate and the personality of the of attention for every minute detail throughout individual are some of the factors that determine the flight. Continuous vigilant work the occupational stress. (Thackray,1981), very high levels of attention Occupational stress has been described as (Levi,1981), situational awareness (Endsley, 2000), an incompatibility between the individual and his frequent roster changes (Cooper and Sloan, 1985), or her work environment (Humphrey, 1998). stress associated with proficiency checks and National Institute for Occupational Safety & constant evaluations (Sloan and Cooper, 1986;

3 1, Centre for Health Psychology, University of Hyderabad, Hyderabad;2Air India, Hyderabad

61 Hariharan et al./ Stress & Coping Styles of Pilots

Lempereur and Lauri, 2006), Person-Environment the stress levels, not much emphasis is laid on (P-E) Fit (Caplan et al., 1975; Van Harrison, 1978; the coping strategies adopted by pilots. Baker, 1985) are stress factors specific to the Assessment of stress only when studied in profession of pilots. Corporate stability (Little et.al combination with the coping strategies provides 1990), organization and its work culture such as a complete insight into the phenomenon. job security (Reddy et al., 1996), adequacy of pay, Coping is defined as ‘the cognitive and lack of control over one’s work schedule, as well emotional efforts made to overcome stress’. as larger issues such as institutional policy, Lazarus & Launier (1978) said that coping consists buffers such as unionization/collective control of efforts, both action-oriented and intra psychic, (Johnson 1995), promotions (Siegrist 1996) are to manage (i.e., master, tolerate, reduce or minimize) common to many other occupations. A number of environmental and internal demands and conflicts studies independently identified various among them. Studies on the coping strategies environmental factors causing stress in the employed by pilots to manage the stress are profession of pilot. Significant among them are scattered and few. Sloan & Cooper (1986) excessive noise (Green et.al.,1991), lack of conducted a study on 442 commercial airline pilots sufficient oxygen (hypoxia) (Fowler, Prlic, & and found that four factors play a major role in Brabant, 1994), effects of domestic stress (Fiedler the coping strategies used by the pilots: stability et.al,1991), cosmic radiation (Rafnsson, 2005), of relationships and home life, reason and logic, interaction effects of noise and heat and social support, and wife’s involvement. Picano interaction effect of noise and illumination (1990) carried out an empirical assessment of (National Institute of Occupational Health, India stress coping styles in US Army military pilots. 2000). Apart from these factors, airline employees Results indicated that the pilots preferred problem- suffer from chronic fatigue associated with heavy focused stress-coping strategies oriented towards pressure and shift work. This has been found by direct action to master stressful situations. Also, two independent studies. Lamond et al. (2006) the pilots tended to deemphasize emotion-focused conducted a study on 19 (ten captains, nine first forms of coping with stress. Differences in stress- officers) international pilots in Australia operating coping between pilots and samples of air crewmen a direct return pattern from Australia to Los and non-rated military personnel suggest that Angeles. The researchers used a Palm Pilot coping style reflected differences in psychological Psychomotor vigilance task to measure the functioning independent from the pilots’ response speed of the pilots in relation to the adaptation to the aviation and military sleep obtained during the international layovers. environment. It was found that pilots with short length layovers Most of these studies on the occupation of had a comparatively poor response speed than pilot and his environment have been conducted the pilots with longer layover. The reasons across the globe. There are Indian studies on the primarily being fatigue due to insufficient sleep. sample of Air Force Pilots. Taneja (2007) studied Pilots who had short length layover got less time the effects of fatigue on 83 military fast jet aircrew to recover from the flight operation in comparison of the Indian Air Force. The results revealed that to pilots having longer layovers. In another recent the increased reaction time, lapses in research Tourigny et al., (2010) studied a sample concentration and poor aircraft handling are of 472 air crew (including the pilots). They found attributed to be significant outcomes of fatigue. that role overload and role conflict are significant One third of the aircrew attributed their drowsy contributors to the stress. In addition, rotation feeling to sleep deprivation. It was observed that shift work was found to be adding to job stress. the aircrew members were not adequately trained While the studies paid attention in assessing to handle fatigue. In another very novel study

62 Hariharan et al./ Stress & Coping Styles of Pilots

Kaushik et al. (2009) tried to identify on the made it affordable for the middle class. This is the consequence of chronic aviation stress in the time when a tough competition between different Indian Air Force (IAF) pilots. A sample of 100 IAF airlines began. As an offshoot of this, aviation officers of Flying branch undergoing routine sector in the country opened ample job annual dental examination during a four week opportunities with attractive salaries and perks. period was taken. It was found that overall 51% As a consequence the civil aviation also of the sample engaged in bruxism which is being experienced high attrition rate among the pilots increasingly associated with stress. 37% of the and other technical staff. subjects were aware of their habit and used it to Objective of the study were to identify stress overcome the stress. The study drives home the levels among different groups of pilots and point that there is ever increasing need, not only examine differences in coping styles among the to acknowledge the effects of aviation related pilots stress, but also to think in terms of preventive psychological measures. Method In another study Joseph, Maitra, Nayar and Reddy (1996) investigated psychosocial stress Sample factors and coping styles on a sample of 76 Indian commercial airline pilots. With the help of interview Commercial airline pilots flying in domestic techniques and inventories they identified the sector were selected for the study. A total of 122 major sources of stress. Results indicated a pilots transiting through Hyderabad airport were statistically significant incidence of both domestic selected randomly. Four airlines are included in and occupational stressors. Increase in domestic the study. Pilots belonging to three cadres such stressors was associated with increase in coping as Commander, Captain, and First Officer are and trait anxiety. Higher occupational stress and included in the sample. The commander is the high anxiety were linked to lowered job highest cadre followed by Captain and First officer. satisfaction, coping and self perceived The responsibility of overall safety and control performance. Factors such as age, seniority, marital of airplane varies along the three cadres, the status, type of organization were found to play a highest resting on the Commander and relatively significant role in influencing stress and low on the First Officer. The sample comprised of outcomes. Leojeeva and Chandramohan (2008) the three cadres are men and women affiliated to identified psycho social stress and coping four different airlines. For the sake of methods in 55 civil pilots by administration of confidentiality, the airlines are identified with the stress questionnaire to discover that 78 % of their codes A,B, C and D. sample had stress, 77 % used emotion focused The sample consists of 111(91%) male and strategies to cope stress, 18 % used problem 11(9%) females. This is highly representative of solving and 5 % relied on social support for the gender distribution in population of Indian effective coping with stress. It is unfortunate that pilots. The distribution of sample across the four the authors have not adequately consolidated. Airlines in terms of number and (percentage) is 66 This study is designed to gain a new insight (54.1%), 22 (18%), 18 (14.8%) and 16 (13.9%). The into the various aspects related to stress and sample constituted of 77(63.1%) Commanders, 11 coping styles among the Indian pilots in civil (9%) Captains and 34 (27.9%) First officers. aviation. The other significant features of the sample This study was conducted in the year 2005- may be described in terms of ranges. The age 06 when Indian civil aviation encouraged the group ranged from 21 to 50 years. The experience private airlines, cutting the frills of its cost and of Subjects was recorded in terms of number of

63 Hariharan et al./ Stress & Coping Styles of Pilots years of service rather than in terms of flying the physical, emotional and social environment hours. This is because some of the pilots have at workplace and the residence. Environmental joined the commercial civil aviation companies Stress Rating Scale (ESRS) is a six point rating after their service in Indian Air Force where the scale consisting of 20 Statements, measuring three experience is not recorded in terms of flying hours. domains of physical environment of the pilots The flying experience of the pilots ranged from viz. Cockpit or Aircraft Physical Environment, less than 5 years to more than 20 yrs. The Residential/ Home Environment and Work Place qualification of pilots in the sample ranged from Environment. The Physical or Cockpit Intermediate to Post graduation. Environment is measured by 9 items. The Residential Environment is measured by 4 items Measures and Work Place Environment by 7 items. The scores ranged from 20 to 120.This Scale Three instruments are used for the study viz significantly correlated with the standardized Occupational Stress Index Scale (OSIS), Occupational Stress Scale (r = .517; p<.01). The Environmental Stress Rating Scale (ESRS) and item analysis showed a high internal consistency. Coping Styles Projective Questionnaire (CSPQ). Environmental Stress Rating Scale was found to The Occupational Stress Index Scale is a standard be an effective instrument to measure the stress test constructed by Srivatsava & Singh, (1984). levels of pilots. Table 1 shows the scores of The Environmental Stress Rating Scale (ESRS) internal consistency of Environmental Stress and Coping Styles Projective Questionnaire Rating Scale. The correlation of dimension scores (CSPQ) are specifically designed for the study. with the total score was highly significant (p<.01) Occupational stress is defined as the stress as shown in the table. experienced by pilots while discharging their responsibility in their professional role, which may Table 1. Internal Consistency of Environmental relate to actual flying conditions, relationship with Stress Rating Scale (ESRS) colleagues along the hierarchy, peer pressure etc. ______Occupational Stress Index Scale is a five point Environmemt Total Score rating scale having twelve dimensions. However, ______only five relevant dimensions are retained in the Physical Environment .870** instrument for this study. The dimensions retained are- Role overload, Role Conflict, Unreasonable Residential Environment .378** group & Political pressures, Poor peer Workplace Environment .765** relationships, and Strenuous working conditions. The dimensions that are dropped are Role ______ambiguity, Persons, Powerlessness, Intrinsic **p< .01 \ impoverishment, Low status, Under-participation and Unprofitability. The reason for dropping the Coping Style Projective Questionnaire is a items is because of their irrelevance to the projective, close ended questionnaire. It consists profession of pilots. The final scale used for this of 12 questions addressing the dimensions of study consisted of 23 items divided into five stress measured in Occupational Stress Index dimensions. The total score ranged between 23 Scale. The response options consisted of eight and 115. The number of items under each different types of coping as per the classification dimension ranged from four to six. of Folkman & Lazarus (1986). These dimensions Environmental Stress for pilots is may be described as follows: Confrontive Coping operationally defined as the stress stemming from

64 Hariharan et al./ Stress & Coping Styles of Pilots

(efforts to alter the situation and suggests some Result degree of hostility and risk-taking); Planful Problem Solving (deliberate problem-focused The results focused on finding out differential efforts to alter the situation, coupled with an stress levels of pilots affiliated to different airlines analytic approach to solving the problem); and studying the coping styles adopted by pilots Seeking Social Support (efforts to seek with highest and lowest levels of stress. informational support, tangible support, and ANOVA was carried out on the stress scores emotional support); Accepting Responsibility of different cadres of pilots to find out cadre (acknowledges one’s own role in the problem with differences in stress. Table 3 presents the results a concomitant theme of trying to put things right of ANOVA and corresponding mean scores on i.e self-blaming with a positive note); Self- occupational stress levels across the cadre. Control (efforts to regulate one’s feelings and actions i.e keeps feelings to self); Positive Table 2. Differences in occupational stress levels Reappraisal (describes efforts to create positive across the cadre meaning by focusing on personal growth i.e a ______feeling that whatever happened is for one’s own Stress factor Cadre / Position Mean F good); Distancing (cognitive efforts to detach in cockpit oneself and to minimize the significance of the situation); Escape-Avoidance (wishful thinking Occupational Commander 62.8 3.241 and behavioral efforts to escape or avoid the Stress Captain 58.18 problem). First Officer 58.64 The subjects were presented with certain anecdotes, where a character encounters certain p<.001 stressful situations. They were asked to choose from eight alternative reactions (each The results of ANOVA revealed that the pilots corresponding to a coping technique) in which in the cadre of Commander experienced higher the character ‘would have’ responded. To facilitate levels of stress compared to other two cadres. easy projection by males and females, the gender The mean score for Commander is 62.8 and appropriate names are introduced for the Subjects Captain and First Officer have scores 58.18 and of the two genders. 58.64 respectively indicating that the Commanders experienced higher stress compared to the Co- Procedure pilots (Captain and First Officer). This corroborates with the fact that the Commander Pilots were contacted either at the Flight from the highest cadre, is responsible for the Dispatch section or in the cockpit of the aircraft overall safety of the aircraft. Hence, it is expected during their transit halts at Hyderabad. They were that by virtue of this they have higher level of explained the purpose of the study and assured stress. about the confidentiality of their responses. Apart from the cadre vested with different They were given the Environmental Stress levels of responsibilities, stress is likely to vary Rating Scale and Occupational Stress Index Scale depending upon the way the organization treat first. On submission of these two, they were their employees. Thus, the pilots’ organizational administered the Coping Style Projective affiliation may also contribute to their levels of Questionnaire. stress. There may be different factors contributing to the stress level of pilots belonging to various airlines. For instance, the Airlines may differ in

65 Hariharan et al./ Stress & Coping Styles of Pilots their choice of aircrafts depending on their policy for flying old aircrafts and faced recurrent technical or the sector they fly. The type of aircraft one flies problems. Subsequently from the year 2006-07 the may provide different levels of physical airline ‘C’ converted its old aircrafts into cargo environment that impacts the level of stress. It and has been mostly limiting its operation to flying may be interesting to observe the difference in in the North-Eastern sector of India using its’ stress levels among pilots belonging to different newly acquired smaller aircrafts. Low pay and high organizations. Table 3 shows the differences in workload, unreliable flight schedules due to the Environmental and Occupational stress among technical snags and stretching of duty time to its pilots from different airlines. limits are some of the factors that probably contributed to high stress levels among pilots in Table 3. Organizational affiliation & differences ‘C’ airlines. Short sector operations necessitate in stress crew to be highly alert for the entire period of duty. The growing competition among the airlines, Airline Environmental Occupational the pay package and perks offered to the pilots Code Stress Stress was reaching new heights in the years 2005-06. High competition, merging of Airlines Mean F Mean F accompanied by the uncertainty of the existence and continuation of the company perhaps are the A 76.94 61.92 significant sources of stress for the pilots of an B 70.19 6.785 54.20 9.672 Airline that had to compete with others. Exodus C 82.72 (p<.001) 68.22 (p<.001) of pilots from ‘C’ Airlines to other upcoming D 74.12 59.47 airlines during the years 2005-06 is the supportive evidence for this argument. It may be relevant to mention here that about 20 pilots had already left It may be observed from the results of Airline ‘C’ by June 2006. ANOVA in Table 4 that differences in the Many of these pilots employed in Airline ‘B’ environmental as well as occupational stress formerly worked in Indian Air Force. Out of the 22 across the organizations are statistically pilots from ‘B’ airlines 14 (63.6%) pilots were hired significant (p<.001). Table 3 shows that ‘C’ airline after their service in Indian Air Force. It can be scored highest on environmental stress, inferred that the reason for lowest stress of pilots (mean=82.72) and ‘B’ was found to experience in ‘B’ Airline is due their earlier tenure with Indian lowest stress (mean=70.19). ‘A’ and ‘D’ have Air Force. Compared to the Air Force, job demands, occupied positions in between with the mean life and the working conditions in the civil flying scores of 76.94 and 74.12 respectively. It is is more rewarding in terms of monitory and fringe observed that pilots from airline ‘C’ showed benefits with fewer controls. significant high levels of stress compared to their It is desirable to study stress along with the counterparts in other airlines. Similar positions coping responses. Table 5 depicts coping are found in case of occupational stress scores. strategies adopted by pilots. The table presents This is expected because of high correlation the Coping strategies of the entire sample. between the two instruments. From the above table, comparing stress levels On eight coping strategies the scores of the of four airlines, it can be observed that pilots of pilots were as follows: Confrontive Coping Airline ‘C’ have highest stress levels and pilots (29.55%), Planful Problem Solving( 25.64%), of Airline ‘B’ have lowest stress levels. It may be Seeking Social Support, (22.57%) Accepting relevant to mention here that Airline ‘C’ was known Responsibility (6.2%), Positive Reappraisal

66 Hariharan et al./ Stress & Coping Styles of Pilots

(15.37%), Distancing (5.47%), Self-Control (1.02%) Stress Group of pilots used more of Planful and Escape-Avoidance (2.04%). Of these the first Problem Solving while High Stress Group is found five may be termed as Active Coping strategies. to opt for Confrontive Coping. Similarly, while the The reason is that the individual is active high stress group is found to have opted for cognitively and emotionally while applying these Seeking Social Support more frequently, the low strategies.. Distancing, Escape/Avoidance and stress group is found to opt more frequently for Self Control may be identified as passive Distancing and Positive Reappraisal. These techniques. In these strategies, the individual strategies may be helpful sometimes to sustain barely attacks the problem or actively manages psychological equilibrium particularly when the emotions. Both these activities are either avoided Locus of Control is perceived to be external. or done at sublime level. Contrary to this, it is found that high stress group From the table 5, it may be observed that the opted for Accepting Responsibility more coping preference of the pilots concentrates on frequently than the low stress group. This four major strategies, viz Confrontive Coping, tendency of coping through self-blaming may Planful Problem Solving, Seeking Social support sometimes result in adding to the stress levels and Positive Reappraisal. It could be either rather than ameliorating it. Similarly relaying on because only strategies are dominantly present Seeking Social Support as a frequent strategy may in their repertoire or they consciously avoid the sometimes result in negative social support. Thus use of passive strategies. Whatever be the reason, it suggests that the differential coping strategies limitation of their choice only to four coping chosen by the two groups are crucial in their stress strategies suggests that they have a rigid style of levels. It is very difficult to locate the cause-effect coping. In order to examine if this rigid style of relationship in their stress-coping-spiral. Though coping is uniform among the pilots or differs with there is a variation of percentage among the extreme levels, a comparison is drawn between groups with high stress scores and low stress the pilots of highest and lowest stress levels. Table scores, in adopting various coping strategies, it 6 presents the coping strategies opted by the is evident from the table, that all the pilots pilots affiliated to Airline ‘C’ (highest stress group) irrespective of organizational affiliation, adopt and their counterparts in Airline ‘B’ (lowest stress mainly four coping strategies, they are, group). Confrontive coping, Planful problem solving, The results indicates tht, pilots of High Stress Seeking social support and Positive reappraisal, Group adopt Confrontive Coping (34%) as the that cover 89% of their strategies. Only 11% of main technique followed by Seeking Social the choices were distributed among the other Support (23%), Planful Problem Solving (17%), coping strategies, which is not a desirable sign Positive Reappraisal (15%), Accepting among the pilots. There may be a situation in life Responsibility (6%), Distancing (4%), Escape/ that has to be avoided or where emotional Avoidance (1%) and Self Control (0%). Contrarily distancing may be desirable for restoring pilots of Low Stress Group have given higher wellbeing. All these strategies are equally vital priority to Planful Problem Solving (30%) followed for the individual to cope better in dealing with by Confrontive Coping (25%), Positive stress. Reappraisal (17%), Seeking Social Support (16%), Distancing (7%), Accepting Responsibility (3%), Discussion Escape/Avoidance (1%), Self Control (1%). The striking difference between the high and the low In the absence of standardized tests to stress groups of pilots seems to be that of measure pilot stress, the Environmental Stress discretion used in choosing a strategy. The Low Scale that highly correlated with a standardized

67 Hariharan et al./ Stress & Coping Styles of Pilots

Occupational Stress Scale is a significant References contribution to aviation Psychology. However, there is a need to administer the scale on a larger Baker, D. (1985). Occupational stress. Annual Review population and standardize it. of Public Health, 6, 367-381. The projective technique using anecdotes is Caplan, R.D., Cobb, S., French, J.R.P., Van Harrison, found to be very effective in identifying the R., & Pinneau, S.R. (1975). Job Demands and possible behavioural reactions. (Hariharan & Worker Health. Cincinnati, OH: National Ramabrahmam, 1998; Karimi, 2006). This technique Institute for Occupational Safety and Health. may be tried on a larger sample to evolve a culture (Publication No. 75-168) specific, occupation specific Coping Cooper C.L., & Sloan, S.J. (1985). Occupational and Questionnaire for pilots. The Coping Style psychosocial stress among commercial aviation pilots. Journal of Occupational and Projective Questionnaire (CSPQ) is found to be Environmental Medicine, 27,8, 570-76. effective with the sample of pilots. Endsley, M. R. (2000). Theoretical underpinnings of This study has found that pilots irrespective situation awareness: A critical review. In M. R. of organizational affiliation experience Endsley & D. J. Garland (Eds.), Situation environmental and occupational stress. This awareness analysis and measurement. Mahwah, corroborates with the recent study by Leojeeva NJ: LEA. & Chandramohan (2008) who found that 78% of Fiedler, N., Bowden, J., McNeil, K. K., Steinberg, M., pilots experience psychosocial stress. The high &Gochfeld,M.(1991). Employee assistance stress level and rigid coping style among pilots is program compliance: impact of contrasting not desirable. Pilot’s role in safety of airplane and insurance coverage. its inmates are of paramount importance and it is Journal of Occupational Medicine: official the responsibility of the airline to help the pilots publication of the Industrial Medical Association, manage their stress effectively. They need to 33, 8, 862-867. monitor the pilots stress levels from time to time Folkman, S., & Lazarus, R.S. (1986) Stress Processes and train the pilots to adopt effective coping and Depressive Symptomatology. Journal of styles. If unchecked, pilots’ stress level may pile Abnormal Psychology, 95, 2, 107-113. up and lead to exhaustion and burn out. In the Fowler, B., Prlic, H., & Brabant, M. (1994). Acute interest of the employees and also the clientele hypoxia fails to influence two aspects of short term memory: Implications for the source of whose safety rests on the ‘wellness’ status of the cognitive deficits. Aviation, Space, & pilots, the airlines need to enhance their efforts to Environmental Medicine, 65, 641-645. minimize the stress and promote flight safety. Green, G.G., Muir, H., James, M., Gradwell, D., & Stress management does not form a significant Green, R. L. (1991). Human factors for pilots. part of pilot training. The airlines must identify Aldershot, UK: Gower Technical Press and endorse the fact that equipping their pilots Hariharan, M., & Ramabrahmam, I. (1998). Total with effective coping skills is an essential welfare literacy campaingns: their social impact- a case measure in their Human Resource training. Specific study of East Godavari District. Indian Journal sessions on training in Stress management and of Adult Education, 59, 2, 15-19 Flexible Coping Style by professional Humphrey, J.H. (1998). Job Stress. Needman Heights, Psychologists may help in equipping the pilots MA: Allyn & Bacon with better wellbeing skills. Airlines must recruit Johnston, J.J. (1995). Occupational injury and stress. trained Psychologists to assess the stress levels Journal of Occupational and Environmental of pilots from time to time and impart training in Medication, 37, 1199-1203. adopting effective and productive coping Joseph, C., Maitra, A.K., Nayar, G.S., & Reddy, I.R. strategies.

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(1996). Psychological stress and coping: a coping styles in military pilots. Aviation Space preliminary study on Indian commercial airline. an Environment Medicine, 61, 4, 356-360. Indian Journal of Aerospace Medicine, 40, 2, Rafnsson, V. (2005). Cosmic radiation associated with 33-40. risk of cataract in airline pilots. Archives of Karimi, M. (2006). A real and perceived environment Ophthalmology, JAMA journals. Web resource of the physically challenged: a comparative study http://www.rxpgnews.com/ of the vulnerable and the invulnerable. Ophthalmology.shtml retrieved on 18th Unpublished M.Phil Dissertation. November, 2007 Kaushik, S.K., Madan, R., Gambhir, A., & Prasanth, Sauter, S., Murphy, L., Colligan, M., Swanson, N., T. (2009). Aviation stress and dental attrition. Hurrell, J.Jr., Scharf, F. Jr., Grubb, R.S.P., Indian Journal of Aerospace Medicine, 53, 1, 6- Goldenhar,L., Alterman,T., Johnston,J., 10 Hamilton, A., & Tisdale, J. (1999). Stress at Lazarus, R.S. (1991). Emotion and adaptation. Oxford: work. Cincinnati, OH: National Institute for Oxford University Press Occupational Safety and Health. (Publication No. 99-101). Web resource http://www.cdc.gov/ Lazarus, R.S., & Launier, R. (1978). Stress-related niosh/docs/99-101/ accessed on 10th November, transactions between Person and Environment. 2007 In Perwin, L.A., and Lewis, M. (Ed). Perspectives in Interactional Psychology, Siegrist, J. (1996). Adverse Health Effects of High- Plenum. Pub. Corpn. Effort/Low Reward Conditions. Journal of Occupational Health Psychology, 1, 1,, 27-41. Lempereur, I., & Lauri, M.A. (2006). The psychological effects of constant evaluation on Sloan. S.J., Cooper, C.L. (1986). Pilots under Stress. airline pilots: an exploratory study. International London: Routledge & Kegan Paul Journal of Aviation Psychology, 16, 1, 113-133 Sloan, S.J & Cooper, C.L. (1986). Stress coping Levi L. (1981). Preventing Work Stress. Reading: strategies in commercial airline pilots. Journal Addison-Wesley Publishing Co. of Occupational Medicine, 28, 1, 49-52. Little, L.F., Gaffney, I.C., Rosen, K.H, & Bender, M.M. Taneja, N. (2007). Fatigue in aviation: A survey of (1990). Corporate Instability is related to Airline awareness and attitudes of Indian Air Force Pilots’ Stress Symptoms. Aviation, Space, and pilots. The International Journal of Aviation Environ.menal Medicine., 61, 977-982. Psychology, 17, 3, 275-284 National Institute of Occupational Health, India (2000). Thackray, R.I. (1981). The stress of boredom and Web resource http://www.nioh.org/ accessed on monotony: A consideration of the evidence. 25th October, 2006 Psychosomatic Medicine, 43, 165-176. Lamond, N., Petrilli, R.M., Roach, G.D., & Dawson, Tourigny, L., Baba, V, V., & Wang, X. (2010). Stress D. (2006). The sleep, subjective fatigue, and episode in aviation: the case of China. Cross- sustained attention of commercial airline pilots Cultural Management: An International Journal, during an international pattern. Chronobiology 17, 1, 62-78 International: The Journal of Biological & Van Harrison, R. (1978). Person-environment fit and Medical Rhythym Research, 23, 6, 1285-1294 job stress. In Cooper, C. L., Payne, R. (Ed). Picano, J.J. (1990). An empirical assessment of stress Stress at work. Chichester: Wiley.

69 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 70-75 Mishra et al./ Emotional intelligence and impulsivity Clinical Psychologists (ISSN 0303-2582) Concurrent Validity of the Luria-Nebraska Neuropsychological Battery

1Deepak Kr. Mishra, 2Sarika Alreja, 3Masroor Jahan, 4Amool Ranjan Singh

Since LNNB is a comprehensive battery, there is a need of shorter form of screening tool to identify probable cases with neuropsychological deficit. The present study was conducted to assess the concurrent validity of a new screening tests consisting of 22 items for literate and of 15 items for illiterate population drawn from LNNB-I (Jahan et al., 2005) with the Screening Test for the Luria-Nebraska Neuropsychological Batter: Adult form From LNNB- II (Golden, 1987). Thirty patients with schizophrenia diagnosed according to ICD-10 criteria and thirty normal participants matched in age and gender were taken for the study. Participants were individually assessed on the Screening Test for the Luria- Nebraska Neuropsychological Batter: Adult form and 22-items (15-items) screening tests to examine the status of neuropsychological functions. A perfect positive correlation was found among the scores on the Screening Test for the Luria- Nebraska Neuropsychological Battery Adult form and 22-items (15-items) screening tests derived from LNNB-I for the normal participants. Significant positive correlations were also observed between the screening tools for the patient and the total sample suggesting fair concurrent validity of 22-items and 15-items screening tests from LNNB-I.

Keywords: Neuropsychological screening test, concurrent validity, screening tests from LNNB,

Since its development, the Luria-Nebraska identify patients who require administration of Neuropsychological Battery (LNNB) (Golden et the full battery. In Indian set-up, LNNB-I is al., 1985) has been used in a multitude of commonly used as it can be scored manually and situations, making it one of the more frequently computerized scoring system is also available. administered test batteries in clinical setting. Since Hence, in doctoral research Jahan (1999) it is a comprehensive battery, various attempts developed 22 items (for literate patients) and 15 have been made to shorten it. Furthermore, users items (can be used for literate and illiterate have also expressed interest in a screening test patients) screening tests from LNNB-I on a sample so that appropriate patients could be referred for of epileptic patients. Later on it was again tested a full assessment. on a sample of epileptic patients and was As a solution to this problem a 15 items published in 2005 (Jahan et al., 2005). screening instrument was developed by Golden Subsequently, Halder et al. (2006) conducted (1987) from LNNB II which has been used to a study with the aim of assessing the cross

1,2,3,4 Department of Clinical Psychology, Ranchi Institute of Neuro Psychiatry and Allied Sciences, Ranchi, Jharkhand. Paper was presented in the 36th National Annual Conference of the IACP held in Bangalore during 1st to 3rd February 2010

70 Mishra et al./ Emotional intelligence and impulsivity validity of these twenty two and fifteen items were matched on mean age and education. Most screening tests from LNNB-I on 60 subjects (30 of the participants were in the age range of 25-32 normal and 30 paranoid schizophrenic patients). years, and studied at least upto matric level and Result suggested that 22 items and 15 items employed. Both male and female participants screening, tests were able to correctly identify were included. Majority of participants were 93% paranoid schizophrenic patients who were Hindu, belonging to joint families and of middle having neuropsychological deficits. There were socio-economic status from semi urban and rural no false negative identifications by 22 items and areas of Jharkhand and Bihar. All participants 15 items screening tests. It was concluded that it were right handed. Schizophrenic patients with can be used as a screening tool to identify of any other neurological disorder/major physical paranoid schizophrenic patient who may need illness were excluded. All participants were co- detail neuropsychological assessment. operative. Informed consent was taken for the Another study has been conducted by study. Priyamvada and Jahan (2009) to assess the cross validity of the twenty-two and fifteen items Tools screening tests from LNNB-I on depressive patients. Results suggested that these screening Socio demographic Data Sheet: To collect tests were able to identify 96.67% depressive information regarding socio demographic patients who were having neuropsychological characteristics and other related information of deficits on full battery. Hence, it was concluded the sample a socio demographic data sheet was that these two screening tests may be used as developed for the present study. screening tools to identify depressive patients Hand Preference Battery (Annett, 1970): who require detail neuropsychological This scale was constructed by Annett (1970). assessment. Based on this scale dominant hemisphere is The present study is an attempt to assess ascertained. the Concurrent Validity of the ‘22-Items’ and ‘15- Positive and Negative Symptoms Scale Items’ Screening Tests from LNNB-I with the (PANSS: Kay et al., 1987): The PANSS include 30 ‘Screening Test for the Luria-Nebraska items on three subscales; 7 items covering Neuropsychological Battery: Adult form’ (ST- positive symptoms, 7 covering negative LNNB II-A). symptoms and 16 items for general psychopathology. Each item is scored on a 7 Method point item specific likert scale ranging from 1-7, and the score ranges from 30 (no symptoms) to This is a cross sectional study designed to 210 (very severe psychopathology). An overall assess the concurrent validity of the 22-Items score of more than 60 indicates a clinically and 15-Items Screening Tests from LNNB-I with significant condition. Its good coverage for both the Screening Test for the Luria-Nebraska negative and positive symptoms and sensitivity Neuropsychological Battery: Adult form (ST- in tracking symptom severity makes it useful for LNNB II-A). research purpose. General Health Questionnaire 12 (GHQ: Sample Goldberg & Hiller, 1979): The GHQ-12 is a self administered screening test sensitive to the A sample consisting of thirty patients with presence of psychiatric disorders in individuals schizophrenia and thirty normal individuals were presenting in primary care settings and non- taken using purposive sampling. Both groups psychiatric clinical settings.

71 Mishra et al./ Emotional intelligence and impulsivity

5. Twenty two-items Screening Test using the Socio Demographic Data Sheet. 22 and (Jahan et al., 2005): This is a 22-items screening 15-Items screening tests from LNNB-I and the test from LNNB-I. These 22-items are derived as Screening Test for the Luria-Nebraska a screening tool to identify epileptic patients with Neuropsychological Battery: Adult form were probable cognitive deficit. Overall classification administered individually to selected participants. rate of 22- items screening test for epileptic and Data obtained was analyzed with respect to normal subjects is 86.7% with sensitivity of 85% the objectives of the study. Performance of and specificity of 93.3% (Eigen Value= 0.672; participants on 22- items and 15- items screening Wilk’s Lamda= 0.598; df= 22; p<0.001) mean and test and the Screening Test for the Luria-Nebraska SD scores were 7.83 and 5.092 with cut-off score Neuropsychological Battery: Adult form was of 13. compared using Chi-square test and Spearman 6. Fifteen-item Screening Test (Jahan et Rho. SPSS 16 was used for analysis. al., 2005): Out of the above mentioned 22 items, 7 items required reading and writing skills. Results Excluding those 7 items, 15 items may be used for patients who are illiterate. These 15 items also On the basis of the cut-off scores on each of serve the same purpose. Overall classification the screening tools patient and normal rate of 15-items screening test for epileptic and participants were classified into above cut-off normal subjects is 83.3% with sensitivity of 80.8% and below cut-off categories. There is full and specificity of 93.3%. (Eigen Value= 0.563; agreement among all the screening tools for the Wilk’s Lamda= 0.640; df= 15; p<0.001) mean and normal sample as all the 30 participants have SD scores were 4.53 and 3.501 with cut-off score scored below cut-off scores on these screening of 8. tools (Table 1). The number of patients scoring 7. Screening Test for the Luria-Nebraska below and above cut-off is 11 and 19 on the ST- Neuropsychological Battery: Adult form (ST- LNNB-IIA, 25 and 5 and 23 and 7 on the fifteen LNNB II-A: Golden, 1987): The adult’s version and twenty two items screening tests of the screening Test for the Luria-Nebraska respectively. To assess the concurrent validity Neuropsychological Battery (ST-LNNB-A) is of 22-items and 15-items screening tests from made up of 15 items taken from the Luria Nebraska LNNB-I, correlation of theses two tests and ST- Neuropsychological Battery: Form II (LNNB Form LNNB-IIA was calculated. Table 2 shows the II; Golden, Purisch, and Hammeke, 1985). The values of correlation among the screening tools purpose of the screening test is to predict overall for the subgroups and the total sample where a performance on the respective full length battery. perfect positive correlation was found between The test is discontinued when 8 or more points all the screening tools for the normal participants. are achieved in the running total. Positive correlations significant at p< .01 were found between the twenty two and fifteen items Procedure screening test from LNNB-I for both the patient and total samples. Positive correlations Participants were selected as per the significant at p< .05 and p< .01 were found inclusion and exclusion criteria. PANSS and between the ST-LNNB-II A and 22 items screening GHQ-12 were used for screening patient and tests for the patient and total samples normal participants respectively. Annett’s Hand respectively. A positive correlation significant at Preference Battery was used to assess p< .01 was found between the ST-LNNB-II A and handedness. Socio-demographic information was 15 items screening test for the total sample. Item collected from participants and reliable informants interpretation of all three screening tests (Table

72 Mishra et al./ Emotional intelligence and impulsivity

Table1. Number and percentage of participants scoring below and above cut-off points of LNBT Screening tools.

Tools Normal (N=30) Patients (N=30) Total (N=60)

Below Above Below Above Below Above No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)

ST-LNNB-IIA 30 (100.0) 0 (0.0) 11 (36.7) 19 (63.3) 41 (68.3) 19 (31.7)

15 item tool from 30 (100.0) 0 (0.0) 25 (83.3) 5 (16.7) 55 (91.7) 5 (8.3) LNNB I

22 item tool from 30 (100.0) 0 (0.0) 23 (76.7) 7 (23.3) 53 (88.3) 7 (11.7) LNNB I

Table 2. Correlation coefficients of the screening tools

Correlation coefficients

Group Between ST-LNNB- IIA Between ST-LNNB- IIA 15 item ST (LNNB I) & & 15 item ST (LNNB I) & 22 item ST (LNNB I) 22 item ST (LNNB I)

Normal 1.0** 1.0** 1.0** Patients 0.340 0.420* 0.811**

Total 0.443** 0.534** 0.830**

** p<0.01; * p<0.05

Table 3. Functional composition of the screening tests

ST-LNNB-IIA 22 & 15 (* marked) items screening tests from LNNB I

Number structure Simple movement of hand* Subtraction and addition Double plane* Memory for words Smooth coordination of hand movement* Memory for geometrical figure Rhythmic tap : model* Phonetic analysis Geometrical figure* Logical relationship Stereognosis* Serial subtraction Visual naming* Smooth coordination of hand movement Clock time Smooth coordination of oral movement Compound grammatical structure* New learning Logical relation* contd..

73 Mishra et al./ Emotional intelligence and impulsivity

Table 3. Functional composition of the screening tests (Contd..)

ST-LNNB-IIA 22 & 15 (* marked) items screening tests from LNNB I

Acoustic analysis Narrative speech : fluency* Appropriate grammatical structure Grammar and spelling Reading text Arithmetic operation: sign Sensory trace: tap* Logical memory* Comprehension of thematic text* Simple concept of formation and definition*

3) shows functional composites of these tests. done only with subgroups of schizophrenia of all three screening tools the comparison of known to have little organic involvement over these the course of the disease. There has been a vast Discussion literature suggesting that several subgroups of schizophrenia have different level of To assess the concurrent validity of 22-items neuropsychological deficits and some of them and 15-items screening tests from LNNB-I, show signs of brain dysfunction. In general, more correlation of theses two tests and ST-LNNB-IIA neuropsychological impairment was reported in was calculated. Both the 15 and 22 items screening chronic/ process/ non-paranoid schizophrenics tests from LNNB-I were found to have significant in comparison to acute/ reactive/ paranoid positive correlations with the ST-LNNB-IIA. schizophrenics (Robertson & Taylor, 1985; These correlations were found to be significant Langell et al., 1987). Hence, these subgroups are for both the patient and normal sample. It was literally comparable to normals for whom a perfect concluded that both the 15 and 22 items screening positive correlation was found between the tests from LNNB-I have fair concurrent validity. screening tools in the present study. Hence, it can be used as a screening tool to Functional composition of the 22 and 15 identify patients who may need detailed items screening tests from LNNB-I (i.e., higher neuropsychological assessment. These findings order motor, tactile, visual, memory and are supported by results of previous studies done intellectual functions, fine expressive/receptive with different psychiatric populations i.e., Jahan speech and reading/writing skills) seems to be et al. (2005) with epileptic patients and Priyamvada more tapping to the basic abnormalities found in and Jahan (2009) with depressive patients. The schizophrenia than the ST-LNNB II-A. The latter only other study which has used these tools with screening tool comprised of items assessing schizophrenic patients and found to be effective simple motor acts, immediate memory, new in differentiating schizophrenics from normals is learning, simple perception, basic arithmetic of Halder et al. (2006). The findings of the present operations, logical relationship which seems to study support the findings of the previous study be more tapping to the profile of deficits found in but the size of the correlations was found to be pure neuropsychological disturbances and smaller than earlier. This may be due to differences heavily depends on other variables like side in methodology as the previous study has been effects of medication, trauma to the regulating

74 Mishra et al./ Emotional intelligence and impulsivity areas of brain, altered state of consciousness etc. (1985). Luria-Nebraska Neuropsychological rather than the psychiatric disturbances in which Battery: Forms I and II, Manual. Los Angles: the neuropsychological impairments are the Western Psychological Services. secondary outcome of the disease process and Halder, S., Jahan, M., & Nizamie, A. (2006) Cross involve impairment of higher order abilities like Validity of 22 items and 15 items screening regulation, planning, coordination, problem tests from LNNB-1 on paranoid schizophrenia solving and self-correction etc . patients. Indian Journal of Clinical The results of the present study suggest that Psychology, 33, 1, 28-34. the 22-items and 15-items screening tools from Jahan, M. (1999). Neuropsychological LNNB I have fair validity and were able to identify functioning and its QEEG correlates in schizophrenic patients having neuropsycho- epilepsy. Ph. D. Thesis, Ranchi University, logical deficit. Hence, it can be used as a Ranchi. screening tool to identify patients who may need Jahan, M., Nizamie, S. H., Nizamie, A., & Khalique, detailed neuropsychological assessment. A. (2005). Twenty two- items and fifteen- items The major clinical implications of the present screening tests from LNNB-1 for screening study are that these 22-items and 15-items neuropsychological deficits. Indian Journal screening tests can be used as screening tools of Clinical Psychology, 32 (2), 125-128. to identify neuropsychological deficits in Kay, S. R., Opler, L. A., Linden Mayer, J. P. (1987). psychiatric patients in short time which can save The Positive and Negative syndrome scale the time and effort of both the patient and (PANSS) for Schizophrenia. Schizophrenia clinician. The 15- Items screening test may be Bulletin, 13, 261-276. used for illiterate psychiatric patients also, Langell, M. E., Purisch, A. D., & Golden, C. J. however, these are not meant to comment on (1987). Neuropsychological differences organic pathology. between Paranoid and non paranoid schizophrenics on the Luria-Nebraska References Neuropsychological Battery. International Journal of Clinical Neuropsychology, 9, 88- Annett, M. (1970). A classification of hand 95. preference by association analysis. British Priyanvada, R., & Jahan, M. (2009). Cross Validity Journal of Psychiatry, 61,303-321. of 22-items and 15-items Screening Tests from Goldberg, D. P., & Hiller, V. F. (1979). A scaled LNNB-I on Depressive Patients. Indian version of the General Health Questionnaire. Journal of Clinical Psychology, 36, 2, 84-87. Psychological Medicine, 9, 139-145. Robertson, B. S., & Taylor, M. L. (1985). Luria- Golden, C. J. (1987). Screening test for Luria- Nebraska measures in neuropsychologically Nebraska Neuropsychological Battery: non- impaired schizophrenics: a comparison Adult and Children’s forms: Manual. with normal subjects. International Journal Western Psychological Services: California. of Clinical Neuropsychology, 8, 35-38. Golden, C. J., Purisch, A. D., & Hammeke, T. A.

75 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 76-86 Venkatesan / Cultural factors in clinical assessmernt Clinical Psychologists (ISSN 0303-2582) Cultural Factors in Clinical Assessmernt: The Indian Perspective 1S.Venkatesan

Cross cultural changes across nations is increasingly compelling practicing clinicians to outgrow their earlier medical models to take a deeper look into these factors in assessment, diagnosis and interventions for persons affected by psychopathology. This paper begins with introductory note on key terms: ‘clinical assessment’ and ‘culture’ before discussing the problems and issues related to their use across diverse cultural backgrounds. There is a growing need for examiners to rise above and balance between narrow ethnocentric concerns; or alternatively, xenocentric over adulation of everything foreign. Further, there is necessity to re-adapt to local issues or perceptions, adopt an attitude of cultural relativism, view problems across narrow borders, and transcend toward trans-cultural assessment too. All these concerns are highlighted and discussed in this paper before charting a tentative agenda for future along these lines in the country.

Keywords:Clinical assessment, culture, cultural relativim, cultural symbols, cultural support

Assessment is traditionally recognized as achievement, aptitude, intelligence, memory, the process or procedure of forming impressions creativity, personality, neuropsychological and making judgments about others. It carries an correlates or psychosocial variables. The purpose evaluative flavor while dealing with the whole of assessment varies from screening, person (Fiske & Pearson, 1970). At a technical identification, classification, placement and level, psychological assessment is the process programming to certification and research of “systematic collection, organization and (Thorndike & Hagen, 1977; Hawkins, 1979; Salvia interpretation of information about a person and & Ysseldyke, 1988; Venkatesan, 1991). his situations” (Sundberg & Taylor, 1962), to Irrespective of its stated purpose, all assessments which is added, “and the prediction of his are based on certain assumptions, which are vital behaviors in new situations” (Jones, 1970). The to especially dealing with any heterogeneous key element in assessment is “the act of acquiring clinical populations. The key assumptions and analyzing information” (Hammill, 1987). underlying clinical assessment are: recognition There are as many types of psychological of individual differences in measured assessment as there are reasons to justify it. The phenomenon; mandatory training for examiners types are classified based on areas being before undertaking any assessment; assessed, whether individual or groups are acknowledging errors in assessment as inevitable targeted, or it is applied to the field of defense, but requiring to be corrected wherever they forensics, education, occupation, business and occur; maintaining a developmental perspective industry, or medicine/health. It can be also during interpretation of any assessment data; and, classified according to their applications for that assessment must be carried out in the context different age/developmental groups as children, of cultural/experiential background of subjects adolescents, adults, women, elders, and so on. There are various approaches to clinical The domains for assessment relate to assessment based on types of decisions to be

1Department of Clinical Psychology, All India Institute of Speech and Hearing, Mnasagangotri, Mysore-570 006

76 Venkatesan/ Cultural factors in clinical assessmernt undertaken. Broadly, they are: (a) normative/ and help in therapeutic planning, programming psychometric; (b) criterion referenced; (c) or implementation (Bech, 2004; Nierenberg & functional/behavioral; and, (d) Sonino, 2004; Venkatesan, 2009). neuropsychological/idiometric approaches. Without going into the details of each of them, Understanding Human Culture which are extensively explained in literature for (a) (Witt et al, 1989; Mash & Terdall, 1976; Singh, All human beings are part of a culture. 1986; Becker & Englemann, 1976; Melin, Sjoden Culture refers to unique ways of life of groups of & James, 1983); (b) (Glaser, 1963; Glaser & Nitko, people. It separates a group from others through 1971; Popham, 1973; Kiernan, 1987); (c) (Halpern its actions. Culture is ‘sum total of customs, arts, & Fuhrer, 1984; O’Leary, 1979; Skinner, 1953; science, political and religious behavior taken as Ulmann & Krasner, 1965; Baer, Wolf & Risley, an integrated whole that distinguishes one 1969; Wahler, 1976; Karoly, 1981; Venkatesan, society from another’. The understanding about 1994b; Venkatesan & Choudhury, 1995); (d) a person remains incomplete unless we try to (Venkatesan & Reddy, 1990; 1991; 1992); in sum, understand his culture. Culture supports limits it may be inferred that no single approach to and builds human development. It gets reflected assessment can suffice for enabling all types of though the person’s language, literature, religion, decisions. music, dresses, cooking, etc. Culture is more than Each approach measures behavioral just material goods. It is also the belief and values phenomena at different levels and answers of the people in that group or community. The different questions to varying lengths and/or scientific study of how culture shapes the depths. Ideally, a combination of all approaches behaviors of a given person or groups of at varying levels or depths is needed to provide individuals falls in the field of anthropology. In a complete and integrated view of the assessed one sense, culture is a set of learned behaviors, individuals (Venkatesan, 1991). beliefs, attitudes, values and ideas characteristic It is vital to distinguish clinical of a person, society or population. The gradual ‘assessment’ and ‘testing’. The latter involves or almost imperceptible absorption or learning of exposing an individual to a particular set of the culture into the individual is referred as questions under specified and structured enculturation. conditions to obtain a score. Testing, as a part of Cultural learning is unique to human beings. the larger process of assessment, entails ‘use of It is an accumulation of knowledge about a set of tasks or questions in order to elicit experiences and information not perceived particular types of behaviors when presented directly by the individuals. It is transmitted under standard conditions and yield scores that through certain symbols. Symbols are signs that have observable psychometric properties’. In have no necessary and natural connection with recent times, the term “clinimetrics” is being the things for which they stand. Symbols are very increasingly used to indicate an approach to important in language. Culture is learned psychological testing concerned with ‘indexes, consciously as well as unconsciously through rating scales and other expressions that are used both direct instruction and observation. In one to describe or measure symptoms, physical signs, sense, culture is symbolic. For example, ‘wearing and other distinctly clinical phenomena’. The bangles’ is a symbol of feminine gender in Indian purpose of clinimetrics is to provide an intellectual culture. While human symbols are mostly home for psychological testing of a number of linguistic; sometimes, they can also be anything clinical phenomena. It is used to assess clinical that is used to represent any other thing. For phenomena, enable diagnosis, make prognosis, example, a flag can be viewed as a symbol for a

77 Venkatesan/ Cultural factors in clinical assessmernt nation. Wearing a red dot on the forehead by xenocentricism. For example, a xenocentric shows men or women or the sacred ash on the forehead preference to watch always English movies while is another cultural symbol for some castes or shunning or making fun of Indian dress or movies. community. For example, a wealthy philanthropist may hear of an obscure disease in a distant country and The salient characteristics of human invest in its research, although the matter is not cultures include its constituent individuals. There entirely pressing within the community that he are various levels in a culture. A national culture resides. Another example is wherein the individual can comprise smaller sub-cultures. For example, shows disproportionate sympathy towards within the Indian culture of dressing, there are deaths in foreign citizens than similar deaths several sub-cultures with variations between reported of their own soldiers. Excessive north, south, east and west. Similarly, for a attachment or even blind fellowship to ones own language, there is sub-cultures of different or others culture can sometimes lead to ‘culture dialects for individuals from high or lower socio- conflicts’. From the life cycle perspective, some economic status or regions within a state. The major life events influenced by cultural practices scientific study of cultural/sub-cultural during human development are birth or child similarities or differences between various rearing practices, toilet training, schooling, groups, communities or nations is called puberty, marriage, retirement and death. ethnography. ‘Ethnos’ in Greek means ‘race or people’. Ethnographers examine different human Uniqueness of Indian Culture cultures by using methods for studying written records, folk tales, myths, language, life histories, It is convenient to make a distinction is questionnaires, surveys, psychological tests and made between ‘ideal’ and ‘real’ culture. Ideal participant observations. culture refers to normative descriptions of a culture given by its natives. Real culture is the Cultures are relatively static as they are actual or professed behaviors as observed on also dynamic. They undergo periodic change, ground. India is a country of pluralism and develop or evolve in a uniform and progressive diversity. Some common ‘ideal’ characteristics manner. The geographical area showing common attributed to Indian culture are: cultural patterns of behaviors among its members is called ‘culture area’. For example, the practice 1. Joint family units are more valued than of worshipping cows as gods is unique to Hindu nuclear family units even though they seem to culture and restricted to our country. The be on the decline nowadays members of any given culture develop a sense of 2. Mother-child affections are glorified and belonging, loyalty, obedience, pride and even worshipped as normal and natural. ownership for their own cultures or its practices. 3. Cooperation, conformity and Over time, the members also develop a feeling collectivism is more valued than rugged and belief that their cultural group or its practices selfishness, deviance, competition, conflict and are superior to others. This phenomenon is called individualism. ‘ethnocentricism’. By contrast, the disposition 4. Dependency, especially of women, of over identification or disproportionate elderly and children, is considered normal, natural preference for products, styles and ideas of and expected. someone else’s culture rather than ones own 5. Overt and excessive expressions of even to t he extent that the individual may view sexuality are considered taboo. them as superior to ones own is called

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6. Several virtues like hard work, honesty acceptable in West. Even gay marriages are being and sincerity is believed to be rewarding in the legitimized. Obviously, the norms and values are longer run during ones life than greed, changing. The practice of Sati (when a Hindu acquisitiveness, hasty short cuts, etc. widow was expected and even forced to commit 7. Avoidance of greed, limiting ones herself to flames along with the death of her desires and wants is considered a virtue. husband) is no more prevalent in the country. 8. Means are valued more than the Child marriages are decreasing. The taboo on attainment of ends. breaking away form joint family to set up ones 9. Service to fellow persons is glorified own nuclear family is also gradually diminishing over seeking benefits to self. in our country. Similarly, in other areas of life, 10.Materialism and consumerism is looked there are visible changes. Individuals amassing down compared to sense of detachment, wealth is no more considered greed; rather, it is spiritualism and value based living an achiever. Thus, while the image of an ideal utopian culture is maintained, the contemporary Compare and contrast some of these Indian society is also forced to grapple with a features with typical stereotypes on an ‘ideal’ real culture that is in a state of uncertainty, western culture which stress on nuclear family, confusion, transition, shift, search and individualism, competition rather than conversion-an essential backdrop against which cooperation, institutionalization of services for one must be prepared to view the ongoing all age groups, etc. For example, a divorce in India challenges clinical assessment in psychiatry and is viewed as disgrace and bad name for the family. clinical psychology. The typical American views it as sign of good respect for individual freedom. Likewise, Cultural Relativism dispensing an advice to a middle aged son/ daughter by an elderly parent or grand parent is It is important to consider the concept of taken with pride or respect in the typical Indian ‘cultural relativism’. It is the view that individual household. owever, However, the same may be beliefs and values systems are culturally relative. dubbed as infringement into ones privacy or That is, no one ethnic group has the right to say personal rights elsewhere. Over time, all culture that their particular system of beliefs and values, undergoes change. Changes are influenced by their worldview, is in any way superior to anyone changing demography, increasing migrations, else’s system of beliefs and values. What’s right shifting international relations, urbanization, for one culture might be wrong for another and industrialization, technology innovations, that’s alright. There is no absolute standard of literacy and education, natural events, right and wrong by which to compare and governance, policy, programs and legal contrast morally contradictory cultural values. enactments, political climate, etc. When the rate Cultural relativism asserts that cultural values are of changes is rapid, there is always a danger of arbitrary, and therefore the values of one culture temporary anomie, social disintegration and should not be used as standards to evaluate the lawlessness until at least a new order or behavior of persons from outside that culture. A equilibrium is established. The modern society is society’s customs and beliefs should be undergoing rapid changes. Social norms and described objectively. In a way, cultural relativism values are changing. For example, remarriage of believes that there are no wrong cultures or widows is no more a taboo. The phenomenon of aspects of culture. It recommends a continuous contract marriages or having children outside strive for objectivity and recommends against marriage is increasingly being considered as making quick judgments about people

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practices or procedures, etc. These shortcomings Issues and Implications for Clinical Assessment become evident only when a neophyte confronts clients in actual clinical practice. It is not unusual The distinctive background and growing for the rural, semi-literate, or economically weak disparity between the ‘ideal’ or ‘actual’ culture in psychologically affected client to avoid direct the country, is beginning to show its dent in actual consultations with western educated psychiatrist clinical practice of psychiatry and/or clinical or clinical psychologist. Many times, there psychology. To begin with, the these twin emerges an intellectual and emotional disconnect disciplines are themselves still struggling to between these professionals and such clients. establish themselves as distinct health delivery Beginning from dress, appearance, to differences systems against the backdrop of the slush in in dialect (if not the language too), to value laymen preoccupation or first preferences for systems, etiquette, manners, customs, or other magic-religious traditional treatments for habits; there is often a clear or visible line of psychologically affected individuals or their demarcation between the typical semi- families. Combine this with the grim situation of westernized professional clinician and his client. growing rural-urban or rich-poor divide, varying It is quite a challenge to dispel the aura of life styles, gaping illiteracy, multiplicity of castes authority as service provider which comes with and sub-cultures, linguistic plurality, religious such exalted position and simultaneously the jingoism and gender differences in the larger feeling of subservience or service receiver by populations-all of which contribute to the poor the patient. The clinician-client relationship understanding of westernized paper pencil tests, seldom slips to an evenhanded platform for or acceptance of psychometry based clinical meaningful transactions or therapeutic testing. Despite these limitations and challenges, counseling practices to occur. the following section seeks to highlight some culture related challenges, problems and issues This inter-cultural difference and challenge related to clinical assessment in mental health between the westernized professional and his practice in the country. typical Indian client becomes pronounced especially when dealing with ethnic-bound (a) Westernized Training psychological disturbances like functional disorders. There are many instances when as a The ongoing training programs, clinician, one has to innovate and resort to procedures and content for developing ingenious ways of interviewing, case history specialized human resource in mental health taking, collection of anecdotal reports, field/home segment in India is largely founded on a western visits, proxy information from significant others, medical model. Graduate, post graduate, pre- neighbor information, use of challenging and doctoral and doctoral students are trained in confrontation techniques to collect details on the national/regional level institutions on western psycho-social fabric behind an apparently schools of thought, theories, paradigms and innocuous psychogenic aphonic. Frequently, one models for understanding or treating human is confronted with an unresolved power game behavior. While this is appreciable, there appears followed by an emotional crisis in a daughter in to be few missing or wanting links when it comes law or mother in law showing up as a lost/hoarse to inputs on cross cultural perspectives, voice, or even as a possession attack! ethnographic studies, phenomenological researches, and adaptation of tools or techniques Traditionally, the doctor-patient to local conditions, translations of clinical relationship in Indian culture has been on a sloped

80 Venkatesan/ Cultural factors in clinical assessmernt platform involving a giver and receiver. The There is considerable evidence to show patient is always at the receiving end in terms of that the patterns of help seeking behavior for getting advice, lectures, sermons, exhorts or mental health problems by individuals or their instructions, commands, orders and homilies from families in the country is radically different from the doctor. The same is expected of and from the similar such practices in the west. Traditionally, clinician in mental health practice. It is not physical illnesses, diseases and disorders are uncommon to encounter enthusiastic caregivers recognized as requiring medical attention unlike bringing their errant wards to the counseling mental health problems. In the first place, many clinics pleading the psychologist to give an psychological problems or conditions are ‘advice or two’ (in the manner of dispensing recognized as basic aberrations in ones tablets!) to better the wrong behaviors of their personality. For example, alcohol dependence or child. Such requests are often accompanied by use of intoxicating drugs is not considered as an admission that they have ‘tried everything in mental health issue, disorder or disturbance. their hands but nothing seems to work’. Likewise, a ritualistic compulsion to do and re-do Therefore, they expect the clinician’s advice may activities is inherently part of several ongoing at least fall properly into the ‘deaf ears’ of the cultural practices in the customs of the land. For affected child. The sought ‘advice giving’ example, visits to south Indian temples carry with (euphemism for their notion of counseling or it certain rituals, practices and procedures psychotherapy) may not be always be for an involving prostrations, paying obeisance and/or erring adolescent or children alone. It could be chanting hymns or going around certain idols for aged person addicted to drugs or alcohol, or for specified numbers of times. Cleanliness and for another middle aged entangled in faulty office notions of hygiene, purity or chastity are over- or extra-marital relationships, retirement blues, emphasized in certain castes and communities. etc. The western notions of non-directive, self- Seclusion or segregation practices are natural part determined, independent choice making, free will of daily life for certain class, caste, categories of and/or autonomous decision making by the people, or at certain times for a gender of people. affected individual does not simply seem to exist Added to all this, deviant or disturbed behaviors in the psychological framework of these clients. within a family or a typical Indian household is generally tolerated to a great extent-as an In this connection, it is also important to individual aberration or a transient curse by the realize that the elitist, convent or western gods for ones misdeeds in the present or past educated clinician is no match in the births. phenomenological existence or world view of the typical Indian native as much as would the Very rarely, there is understanding that dictates of any local saffron clad, hairy and ash psychological issues could be a medical or health smeared religious/spiritual leader reciting esoteric problem. For example, the aged and elderly with hymns and dispensing advice. Even the most features of delirium, dementia or disturbances may severely angry or agitated psychotic can be be cursed in private but tolerated in the household temporarily subdued by the gaze or touch of such as an inescapable aberration awaiting salvation dispensers where even a few shots or vials of though death. An adolescent with chronic sedatives may fail to induce calm in such schizophrenia or another middle aged with a individuals. personality disorder (by western systems of classification) may still be endured as possible (b) Patterns of Help Seeking Behavior outcomes of gods punishment for the affected person’s or owing to the collective sins of the

81 Venkatesan/ Cultural factors in clinical assessmernt family members in the past births. It being and their ‘actual use of management techniques’ perceived so, the family seeks for solutions from for handling problem behaviors in children. The magico-religious practitioners, astrologers, findings revealed some uniquely idiosyncratic mendicants, mind readers, family gurus, and the and culture bound perceptions that enabled like. Sometimes, the aberrant behavior is optimize the intervention programs for benefit of misunderstood and may be revered as an the problem behavior children and their parents. expression of supernatural manifestation in the For example, the finding that a parent believes in affected patients as it once happened with reports a supposedly evil star or one’s fate as ‘cause’ for of sleepless and not eating patient with catatonics problem behaviors in his or her child may simply stupor who was mistaken for a mystic with god delay or deny the behavioral remediation program. given powers; or the recent news on a person In the same investigation, it was also found that with frank paranoid schizophrenia, who parents made use of several techniques-all at incarcerated his family within the four walls of once, for management of problem behaviors in his house for over a decade in the heart of their children; thereby not yielding any fruitful Mumbai in India! . results. Then, there are instances of several cases in actual practice when every clinician (c) Differential Cultural Perceptions encounters ‘marginal’, ‘borderline’, ‘at risk’ or ‘not yet diagnosable’ cases or conditions who A critical feature of cross cultural do not as yet fit into official text book descriptions considerations in clinical assessment is the frank of diagnostic categories. Yet, owing to a severe admission and acknowledgement by the sub-cultural impoverishment, incongruity or examiners that differential perceptions exist irregularity, for example, a child may show early across cultures, groups of people or communities expressive language delays or another adolescent on or about various mental health issues. For entering college from a rustic background example, in a recent study on reasons for school stammers in certain social situations owing to drop outs, it was found that there are acute untrained soft skills, assertiveness, or poor differences between parents, teachers and the command on a much valued foreign tongue are affected children themselves. The teachers gave all instances of repairable conditions by mere reasons faulting parents or parenting, while the cultural or simple environmental shifts. All these parents reversed the coin on inadequacies in observations strongly recommend the need to teachers. Meanwhile, the drop out children incorporate the cultural dimension within each blamed their parents, teachers as well as the and every clinical assessment practice or impoverished school environment for their not paradigm in the country. being interested in continuing their schooling (Venkatesan, 2009). A similar report was made on (d) Cultural Adaptations differential perceptions in parents, teachers and clinically affected with scholastic/academic A line of needed research in our country is problems (Venkatesan, 2010). The idea of the periodic revalidation of antiquated tests and differential cultural perceptions was innovatively clinical assessment tools or procedures. Ours is and gainfully used in the understanding or probably the only country where psychometric analysis of problem behaviors in children tests developed or standardized decade ago or (Venkatesan & Vepuri, 1993). In this study, the those that have been developed abroad are routine steps in behavior analysis was modified directly used to make standard comparisons of to add two more steps on parent/caregiver individuals in the present. The norms and manuals perceptions on or about their perceived ‘causes’ prepared in the west or those prepared in bye

82 Venkatesan/ Cultural factors in clinical assessmernt gone era or for so called ‘normal’ persons are history of mankind, either in India or outside, the directly used on clinical populations. In most persons who were deformed, disfigured, disabled, instances, there are no adaptable or adjustable deviant, delayed or different was seen as norms for mentally ill, those with special needs, ‘outsiders’ or ‘others’. The criminals, beggars, minority groups, the rural, under privileged, sex workers, transvestites, disabled, sick and neglected, discriminated and marginalized. In a paupers were all belonging to the same lot. They way, the use of archaic norms is equally unfair as were seen as victims of their own wrongs in their it is to use the norms of another nation or previous births, or embodiments of evil spirits. community for making comparisons of clinical Hence, they were looked down, despised and cases in a contemporary generation. The disliked by one and all. For example, it is believed importance of culture fair and culture free tests even now that telling lies would render one mute require no reiteration at this junction. Rather, what or hearing evil makes one deaf. Obviously, these is needed currently is culture upgraded versions dictums are means of social control to have too. To name a few, there is need to take cues checks on the conduct of citizens. from papers addressed to reporting revalidated Simultaneously, some earlier communities went norms for popular tests, such as, Bender Gestalt ahead to dub the deformed or disabled as witches, Visuo Motor Test, Binet Kamat Intelligence Scale, sorcerers, charlatans, or disguised Gessell Drawing Test, Seguin Form Board, Play representatives of the evil. Activity Checklist for Mental Retardation, Most mythological characters depict Mathematics Anxiety Rating Scale, Parental villains or vamps as either, blind, single eyed, Attitude Scale, etc. Updates and revalidation of long headed, deaf, lame, crippled, cretins, and normative or diagnostic tests not withstanding, hunch backs, knock-kneed, deformed, dwarfed, there is equal need to keep upgrading intervention ugly, grotesque or insane. In a sense, culture based tests, scales, procedures and batteries, reacts with dread, fear, guilt, shame, or hate; and such as, Behavior Assessment Scales for Indian at another end, there is pity, sympathy and Children with Mental Retardation (BASIC- compassion. These persons were once isolated MR)(Peshawaria and Venkatesan,, 1992), Activity from mainstream society into asylums usually Checklist for Preschool Children with constructed even farther away from crematoriums Developmental Disabilities (ACPC- and graveyards. These systems continue to DD)(Venkatesan, 2004), and others. There is need thrive even today albeit in disguised forms. There for clinical assessment tools and procedures with are still doubts if having these persons in the greater ecological validity than even the homes will affect the so called ‘normal’ people. traditional pillars of standardization viz., reliability, There are doubts if they are contagious or validity, standardization, and bias (Anastasi & infectious too. if pregnant woman sees the face Urbina, 1997). of a deformed or mentally unsound person, there is risk of giving birth to a deformed child. People (e) Changing Models and Paradigm Shifts: avoid close contact with them. They prefer to Redefining Handicaps send them out of their homes. It is believed that these persons portend calamity or misfortune for The importance of social and cultural someone venturing out on some important task dimensions in clinical assessment becomes or assignment. Marriages or alliances with families apparent when we consider the history of having such persons is avoided or declined. changing models and paradigm shifts with There are fears whether association with them respect to understanding of persons with a would anytime make them to ‘loose’ their mind. difference in any society. Much earlier, in the Any other normal individuals’ violence or anger

83 Venkatesan/ Cultural factors in clinical assessmernt might be otherwise condoned as an eccentric Take the example of a deaf individual. He is behavior or disturbed mood. But, if the person is forced to learn the language and communication affected, each and every action of such a person of the majority non-disabled in his community. is immediately attributed as due to that disease He is expected to listen to announcements made or disability! orally in public address systems. He must sit in a Unlike in the West, the historical scene on crowd of students in a thickly populated or noisy the life and circumstances of persons with classroom to listen to a lecture. If he faces differences in India has been different. They were difficulties in these activities, he is dubbed as seldom cast away completely from mainstream disabled. The human rights model argues that society. Except in cases of violent mental the disability is not so much in the individual illnesses or homicidal behaviors of some persons, who is hard of hearing. Rather, it is the unfriendly the typical Indian reaction for mild differences or ignorant cultural milieu that magnifies the was one of pity and sympathy. They are accepted disability rather than the abilities in the person. If as part of regular society in spite of periodic only the majority non-disabled persons could expressions of community level love, hate, share an obligation to learn or even accept the ridicule, dislike, joke, fears, or other reactions. impaired person’s sign language, there would not There are instances of dwarfs and hunchbacks have been any problem at all. Similarly, if there being employed as jesters in the courts of Indian had been enough signage in the public places rulers or now in the circuses. However instead of speaker announcements, the person demeaning, this royal patronage afforded them would not have experienced any handicap at all! some measure of social security. The naïve, Likewise, the physically challenged person innocents or slow learners were part of the court is expected to negotiate a flight of stairs to reach attendants or jesters. On the whole, the prevailing a public utility service located on higher floors. If society in those days did not find any great need it was culturally made mandatory to provide to establish institutions separately for the ramps instead of short steps or railings and disabled. special toilets, the persons with locomotion In recent times, the situation is changing. disabilities would not have experienced any Clear distinctions are being made between handicap at all. A provision for low height impairment, disability and handicaps (WHO, furniture, switch boards, or other gadgetry would 1980; WHO, 2002). While ‘impairments’ are save the dwarf from the ignominy of public recognized as a ‘physical or anatomical loss’, inconvenience and ridicule. In recent times, greater ‘disabilities’ are termed as the resulting importance is being given to such cultural or ‘functional deficits’, ‘handicaps’ are viewed as a environmental access issues. They are issues social/cultural disadvantage resulting or related to inclusion or integration rather than consequence of impairment as well as disability. seclusion or segregation of these individuals. In being defined from the socio-cultural Where access is inappropriate, inadequate, perspective, it is obvious that there are a host of difficult or ignored, advocacy processes are being environmental or contextual factors that initiated to address situations and promote the commonly impact on the participation of the rights of these persons. In many instances, affected individual in several socio-cultural viewed from this perspective, most problems activities. Arguments are on now whether the faced by the segment of called clinical population problems and issues faced by affected persons emanate from ones membership in a given culture. are the intentional or unintentional making of the A benevolent, accommodative, barrier free and majority group of non-affected persons. accessible milieu minimizes the experience of

84 Venkatesan/ Cultural factors in clinical assessmernt handicap as compared to another hostile, the west, the average viewer in the country is yet negative, and cursing cultural environment. to reach a state of satiation or insulation from the continuing attack of messages from the television (f) Cultural Symbols or films. Most people are still vulnerable to media stereotypes, subliminal messages, concealed Another theme for consideration in the instructions or subtle suggestions albeit context of clinical practice is cultural symbols. In unknowingly or unwittingly. Although a way, culture itself is an embodiment of various apparently unreal, ideal, or intangible, many constellations of symbols. A symbol is something mothers are on the perpetual hunt for that magic verbal or nonverbal within a particular language chocolate drink which could turn their average or culture that comes to stand for something else. or below average performing child ‘taller, stronger While human symbols are mostly linguistic; and sharper’; or their daughters more ‘fair and sometimes, they can also be anything that is used lovely’ through application of ointments. The to represent any other thing. Cultural symbols media created hype of a ‘perfect or complete have idiosyncratic but shared meanings of their gentleman’ donning particular apparel or riding a own for representative members of that group or given brand of car are not to be considered as community. Workers in clinical practice must be fictitious imagery. They are as real or live cultural conversant with the meaning, significance and typecasts as is the naïve question of a mother functional importance of these cultural symbols. who once asked us as to why her child had A patient, for example, may prefer to rely on a developed the habit of persistent lying despite talisman or wrist band offered by a family guru to her giving him a particular make of toothpaste derive immense subjective strength-and yet, may which promised that kids who use that brand seek a second opinion, self-disclosure or approval never tell lies! for the same from the clinician. Although seemingly exaggerated, the web A strong cultural symbol and client world of fascination, fashion and fiction created expectation from family gurus, wayside by mass media and now the web world is a real astrologers, soothsayers, fortune tellers or such culture in the minds of the modern masses, other common man’s helping professionals in whether it is related to movies depicting expensive Indian society is ego comforting guidance and wedding ceremonies, serials on elaborate directive prescriptions for any or all of their emotional exchanges between the ladies-in-law personal problems. The more directive, in typical Indian households, the glorification of commanding and authoritative the guide is, negative heroes and crime through their repeated blended with a façade of grey hair, seniority and telecast, or the denying of child development by age, the more accepting they are for the client. rushing kids into premature adulthood by holding Unlike in the west, younger age or higher degrees song, dance, drama or humor contests and reality or educational qualifications is no guarantee to shows for the new breed of ‘kidults’, or the escape the direct doubt and question of an aged proliferation of passive spectator play by grandmother, for example, who is wont to ask broadcasting large doses of a game played by ‘how many children do you have?’ before she some active few and watched by several millions accepts the behavioral counseling on home of passive viewers, or even the vicarious management of problem behaviors for her satisfaction of viewing others winning huge prize grandchildren! moneys in gamble shows. The mushrooming cultural scene in the Online assessments, chat rooms, e-based country is being dominated and dictated by the discussions, consultations and therapeutic self newfound onslaught of visual media. Unlike in help groups are becoming increasingly popular

85 Venkatesan/ Cultural factors in clinical assessmernt even in our country. A recent paper on content Psychotherapy and Psychosomatics, 73, 134– analysis of transcripts derived from data mining 138. of 3436 email exchanges in a organized internet Nierenberg A A, & Sonino, N. (2004) From clinical group on of netizens revealed that many parents observations to clinimetrics: A tribute to Alvan R. Feinstein. Psychother Psychosom ; 73, 131– are lost in the quagmire of information overload 133. as they discuss/seek more than 238 types of Venkatesan, S. (1991). Bender Gestalt Visuo Motor treatment for children on the autism spectrum Test as Measure of Intelligence in Mentally (Venkatesan and Purusotham, 2008). Unless the Handicapped Individuals. Indian Journal of contemporary clinicians become computer savvy Clinical Psychology. 18, 1, 7-9. there is likelihood of their being left behind in the Venkatesan, S. (1998). Revalidation of Seguin Form ongoing race between man and machine. Further, Board Test for Indian Children. Indian Journal the calamitous outcome of over involvement of of Applied Psychology. 35, 1& 2, 38-42. contemporary human living with machines in Venkatesan, S. (2002). Reappraisal of Bombay- Karnatak Version of Binet Simon Intelligence preference for human interactions have also Scales (1964), Indian Journal of Clinical resulted in loss of social niceties, emotive skills, Psychology. 29,1, 72-78. person to person exchange competencies, and Venkatesan, S., & Purusotham, P. (2008). A Profile of the like-all of which is an important material for Etiological & Therapeutic Searches by Netizen investigation in the field of positive mental health. Parents/Caregivers of Children on the Autism This has been demonstrated in another paper on Spectrum. Journal of All India Institute of Speech the 24-hour activity log of typical kids on the and Hearing. 27, 89-94. autism spectrum and those with developmental Venkatesan, S., Basavarajappa, & Divya, M. (2007). disabilities which reported the amount of time Seguin Form Board Test: Field Try Out on a Modified Procedure of Test Administration. spent per day on needed constructive activities Indian Journal of Applied Psychology. 44, 1-5. like ‘home teaching’ (4.32%) or ‘playing with Wen-Shing, T. (1997). Culture and Psychopathology: peers’ (4.12 %) are meager (Venkatesan, 2004). A Guide to Clinical Assessment, New York: Brunner/Mazel. Conclusion Westermeyer, J. (1987) Cultural Factors in Clinical Assessment, Journal of Consulting and Clinical In, sum, all this goes to show that the Psychology. 55, 4, 479-487. modern clinician must necessarily synthesize and connect oneself to these realities for optimum performance in the practice of their helping profession as well as to reach out more effectively to the masses in the country.

References

Anastasi, A, & Urbina S. (1997) Psychological Testing (7th edn.) . New York: Macmillan. Basavarajappa, Venkatesan, S., & Divya, M. (2008). Normative Data on Seguin Form Board Test. Psychological Researches, Indian Journal of Clinical Psychology. 35,2, 93-97. Bech P. (2004) Modern psychometrics in clinimetrics: Impact on clinical trials of antidepressants ;

86 Indian Journal of Clinical Psychology Copyright, 2010, Indian Association of 2010, Vol. 37, No.1, 87-88 Clinical Psychologists (ISSN 0303-2582)

Book Review

Advances in Cognitive Science, Volume 2, Editors: Narayanan Srinivasan, Bhoomika R. Kar, Janak Pandey, Sage, New Delhi, 2010, pp.295.

In last few decades, enormous expansion has attention, for its innovative experiments. It taken place in the domains of experimental explores the role of landmarks in map-based research on human cognition. The role of navigation particularly the alignment effect in cognition, both, as a mediating variable as well peoples’ day to day lives. The subsequent as a significant determinant of human chapters deal with some of the frontier areas of performance has been re-examined rigorously by cognitive neuroscience. The ‘actor-critic- using new experimental paradigms. This has explorer’ (ACE) paradigm attempts to explain the revolutionized our current conceptualization of role of indirect pathway of basal ganglia in human behaviour and as a consequence, reinforcement learning in mammalian brain. The cognitive science is born as a vibrating discipline, chapter puts new light on role played by the attracting scholars across disciplines. Subthalamic Neucleus and Globus Pallidus In this context, Srinivasan, Kar and Pandey’s externa of basal ganglia in exploratory behaviour present work, Advances in Cognitive Science, The section on Perception and Attention has Volume 2 is the second contribution to this series four interesting chapters. It provides glimpses on Advances in Cognitive Science published by of the exciting explorations that has occurred in Sage, India. The editors have attempted to bring neuroscience of attention. Ladavas and Serino together some of the exciting developments in have written about peripersonal space (the space this discipline, right from the experimental just surrounding the body) representation in research on basic associative processes and humans and narrated the accumulating evidence peripersonal space representation, to brain of plasticity in peripersonal space extension that networks of attention and their application in occurs due to tool-use. The subsequent chapter understanding cognitive remediation of dyslexia. by Sereno and associates provides a The editors have successfully orchestrated the neurophysiologic model of reflexive spatial works of at least 40 contributors across the world attention supported by electrophysiological from various disciplines in this single volume. data. This has immense potential for application The book has 15 chapters, which are being in improving human performance that require organized in three sections, heavily illustrated perception of space. A comparative view of this with figures and diagrams to make the reading model is presented in the backdrop of the previous easily and comprehensible. models of visual attention. Srinivasan and his The opening chapter on Learning and colleagues’ review on effects of emotions on Memory provides a theoretical analysis of basic selective attention and control presents some of associative processes by making a comparative the exciting and findings on the subject. analysis of the existing learning paradigms. The Mavritsaki and associates experimental study analysis also incorporates the current empirical offers a Search over Time and Space (SoTS) research on cognitive impairment in animals and model of neuropsychological deficits through the application these findings for understanding of spiking neural network. The model can have cognitive deficits such as Korsakoff’s disease. implications for neuropsychological The article on “reading maps” deserves special rehabilitation of people with brain damage.

87 Jena/ Book Review

The section on Time Perception has been programmes for dyslexics: PASS Reading the area of convergence of many disciplines right Enhancement programme (PREP) and Fast from the philosophy to neuroscience. The four ForWord Training Prgramme. The authors also chapters presented in this section represent the provide a wide range of neuroimaging data to current trends of research in this domain. It substantiate the neural effects of intervention included very specific responses such as and have advocated the use of Mismatch saccadic eye-movement in estimation of stimulus Negativity (MMN) as a parameter for assessment duration and illusory biases, role of brain in of auditory processing deficits in dyslexics. This duration illusion, the concept of implicit timing, chapter will be certainly of particular interest for as well as cerebral activation in time estimation. the professionals engaged in applied research The section on ‘Language, Cognition and on dyslexia. Development’ presents two chapters on dyslexia. On the whole, Narayanan and his associates Kar and Shukla’s article on ‘Effects of Auditory have made an excellent contribution by bringing temporal Processing in Dyslexia: A Overview’ out some of many exciting works in the field of presents to burgeoning scientific evidence cognitive science, effectively orchestrating some explaining the role of auditory processing deficit of the frontline researchers on the subject. The in dyslexia and explores the neural correlates of book deserves wide attention of scholars across dyslexia . The last chapter by Posner and Kar on disciplines who are engaged in the study and ‘Brain Network of Attention and Preparing for applications of cognitive science in various School’ focuses on two major remedial domains of human performance.

S. P. K. Jena Department of Applied Psychology University of Delhi, South Campus New Delhi, 110 021

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