Erika Fitz '94 on Schafer on Case 13 on Card 18 G.F.

Schafer presents the following thumbnail sketch of the subject: The following stories have been selected from the protocol of a married, Jewish woman of 44, of average intelligence, with a manic-depressive history of long standing and currently in a hypomanic phase. The stories illustrate hypomanic reliance on the defense of denial, especially in the form of reversal.
He then quotes the following response to Card 18 G.F.:
It looks like he has got a hold of her and he's . . . he's kind, he's not angry. Or is it a she? It's her mother, it looks like. A woman and another woman and the woman that is standing is trying to tell the other woman something. It is for her own good. And the one that is leaning over the bannister doesn't look pleased about this, telling her what she is telling her. I don't know what she is telling her. She seems a little, the one that is leaning over the bannister looks as if she might have been a little bit upset. She is not upset now. I can't see her face so it is hard to tell. The other woman looks as if she is telling her something for her own good. She has a very kind face . . . her hands, the one that is leaning over, her hands seem determined but her hands are very kind. The other one seems limp as if to say, I've had enough. That's all I can think of. (What's going to happen?) I really can't say. I don't know what they are talking about. This one leaning over the bannister might come around because the one leaning over her is trying so hard, and seems to be pleading -- to have a pleading expression on her face.
Schafer then comments:
(1) This story is strewn with denials by reversal, negation and minimization. And again the inexorable bad mother emerges: the lower figure is "limp . . . I've had enough." Of course, the patient's chaotic struggle to maintain the benevolence of the mother itself implies the image of the evil mother as well as the regressive search for a happy sense of union or fusion with a good mother -- for immersion in the motherly woman. (2) The "nice horse" of Card 2 is paralleled here by "her hands are very kind." (3) Seeing the upper figure as a man, even if only briefly, is a severe enough distortion to suggest psychosis by itself.
As part of the 1994 take-home final in Psychology 212h, I asked for a critical analysis of this response and of Schafer's interpretive comments in light of the woman's presumed intelligence and hypomanic state. Here's what Erika Fitz '94[1] had to say in response:
3. (a.) The subject's responses very often reject unpleasantness and go out of their way to avoid conflict situations. After leading up to the brink of a conflict--"he's got a hold of her and he's"--the subject pauses, then very deliberately denies the next logical step by saying "he's not angry." Later, those same hands that have "got a hold of her" are "very kind." One of the characters was upset but "is not upset now." Because both we and Schafer know that the patient is disturbed, we are more likely to label these avoidances of conflict as dysfunctional rather than ignore them or think of other explanations, especially since she is known to be in a hypomanic phase of her illness, in which conflict is often categorically denied. This is not necessarily a "bad" bias. The examples do stand pretty well on their own as denials of conflict, but knowing to look for them by being cued into the patient's history gives some clues about what kinds of issues are stewing beneath her illness, rather than just that she is ill and what her diagnostic label is.

That the woman was of average intelligence satisfies us that strange reactions are more likely due to illness than to idiocy. The information about religion and marital status doesn't seem to have been used, at least not obviously, unless Schafer shared the stereotype of Jewish mothers as VERY enmeshed with which I grew up. Knowing the responses of the other TAT cards is the most helpful information. If responses of conflict denial have been thematic throughout the test battery, especially if this is true for testings on several occasions, it is much more likely to be dysfunctional.

A close reading of this case response yields an interpretation which diverges somewhat from that of Schafer. In the beginning, the subject says "he's got hold of her" about a picture generally thought to depict two women. The "he" seems to refer to the upper figure, whose hand is showing, which is what Schafer assumed was meant. However, since the lower figure is more ambiguous, it is the more likely of the two to be construed as male. The lower figure is the likely "he" for several reasons. First, it is the patient's first impression, and at first glance, it is not inconceivable that the diagonal line of the lower figure's body appear to be an arm supporting ("holding") the upper figure. Second, the figure first identified as a man is the one who is shortly changed to a woman, more specifically, the other figure's mother. Given the patient's age, she is much more likely to imagine an older mother figure. While the lower figure's profile rather resembles a sagging bustline, the face of the upper figure is rather decidedly young. Additionally, the woman described as trying to tell the other something (the mother) is the one also described as "standing." Schafer assumed this to refer to the upper figure just because of height. However, the two figures are on a staircase so the lower could be standing further down while the upper is perched on or on the other side of the banister. The upper figure doesn't appear to be "telling" anything, but rather she "doesn't look pleased," which is how the other woman, the one "leaning over the banister" is described. The upper figure does appear to be "leaning over" more than the lower one, who is leaning back..

The fact that the patient's immediate reaction responded to the less obvious person in the picture (the lower figure) first, and then identified that figure with a mother who has "got a hold of" the other, clearly unhappy figure, is more indicative of mother issues than any other piece of information which Schafer identifies. Schafer also, having understood the upper figure to be the one referred to as male, might make a serious misjudgment in censuring the patient psychotic based on this fallacious interpretation "by itself."

There is an interesting quirk in the interpretation as I have presented it here. Tracing the characters' roles in the story as I have laid them out, the upper figure would be the one referred to in "I can't see her face so it is hard to tell." This might be explained by the fact that the upper figure's face is shadowed, but it's possibly a confusing or reversal of the roles of the two women. Role reversal also happens in the last sentence. The "one leaning over the banister," that is, the upper figure (we know this because her hands are described as "kind" while we can't see the other figure's hands), is now seen to have the other "leaning over her." Moreover, this happens in a "pleading" situation, presumably stressful for the patient since the other responses to conflict deny the unpleasantness, and even here the subject thinks the conflict might be resolved by one of the characters compromising ("coming around"). Therefore, some issues about boundaries and identity, especially in the mother-daughter relationship, seem to be implied; another aspect of the patient's pathology that Schafer has not addressed.

b. The first sentence of Schafer's interpretation is fair and accurate. That a negative image of the mother emerges is true. That there are issues there, and tension between negative and positive mother images is also true. However, Schafer rather risks his credibility by the dramatic manner in which he discusses these things, possibly because he has misunderstood the patient's references and her constructions consequently appear psychotic. There isn't clear evidence that the patient is portraying the mother as "bad," "inexorable," "evil" as he says, nor that she is seeking "immersion in the motherly woman." On the other hand, he comes closer to the mark with this last sentence, as boundary issues do seem to exist. Therefore, it seems plausible that the subject would have issues around questions like "how much of me is my mother?" but Schafer's interpretation implies something quite different about the image of mother as good, of woman as motherly, etc. The first question is a rather universal one, but it does lead to less unusual TAT responses than this subject's in most of the population.

The woman's MMPI score could be introduced to help with interpretation at this stage, but it is probably more helpful as background information. While the TAT is projective, the MMPI is empirical. Granted, it will bias the interpreter, and one must be careful of jumping to the kinds of conclusions Schafer has with the psychosis, but is also a good balance to the subjectivity of one clinician. It is naive to suppose that Schafer wouldn't have had some guess about her MMPI-9 score anyway, since the patient has a long standing history of manic-depression and is known to be in a manic phase. Additionally, she probably behaved like a manic person, which would not lost on an experienced clinician. It is helpful to note that an average or low scale on something else like psychosis, might be enough to reject erroneous diagnoses of rare disorders based only on scant TAT information.

[1]The MMPI comments made by Erika will be undestandable in a couple of weeks. Used with the permission of Erika Fitz. Do not quote or reproduce for purposes other than those of Psychology 212h.