The relationship between the Rorschach index of egocentricity and conscious fantasy content in acute schizophrenia

Traditionally, the concepts of narcissism and egocentricity have been used to explain the regression which occurs during a psychotic break. More recently, in his structural sunmary for the Rorschach, Exner has developed a ratio which he relates to these theoretical concepts, the pair-reflection index; but the validity of the relationship particularly among psychotics, is inconplete. The thesis reports the results of a study which examined this structural feature of the Rorschach test, with the intention of further defining the parameters of the term "egocentrism", and to give sane indication of the type of person who makes a large number of pair-reflection responses on the Rorschach. The index was examined by testing its relationship to self-reference and other defined variables in conscious fantasy. Subjects were 30 patients admitted to a hospital inpatient service and diagnosed as acute schizophrenic, a group assumed to exhibit predicted characteristics of egocentricity. The subjects were administered the Rorschach and asked to make up three stories: 1) an original story with no special instruction (type-I); 2) an original story in response to TAT card #12BG (type-II); and 3) an original story about self (type-III). Stories were rated according to a Fantasy Rating Scale developed by Baker (1976) along a number of dimensions. As hypothesized, it was found that the group scored significantly above the normal range on the index as found by Exner. While a significant correlation was not found between a higher score on the egocentricity ratio and number of self-references, post hoc analysis shewed that 73% of type-I stories and 47% of type-II stories were spontaneously made up about self or self intruded upon the story. A profile was constructed for this diagnostically hanogeneous group in which characteristic traits included: low degree of emotional differentiation and expression, low level of interpersonal interaction, low level of perceptual construction and integration (fragmentation, juxtaposition, syncretism), and low level of cognitive construction and integration. The results are further examined in terms of object relations theories of narcissism and Piaget's notions of egocentricity. It was concluded that in this group of schizophrenics scoring high on the Exner pair-reflection index, cognition and perception reflect a diffuse, undifferentiated self-system. Undifferentiated is used in the way that object relations theorists have defined it and in the way Piaget has used it to describe egocentricity in the child. In brief, simple terms, subject and object are confused and the individual does not maintain a clear sense of identity and differentiation from other objects in the environment. This results in an increased preoccupation with self which affects basic inodes of organization and an isolation which reduces the degree of consensual validation, or knowledge of common meaning.